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NATURE IN DISEASE, 



ILLUSTRATED IN 



VARIOUS DISCOURSES AND ESSAYS. 



TO WHICH ARE ADDED 



MISCELLANEOUS WRITINGS, 



CHIEFLY ON MEDICAL SUBJECTS. 



BY JACOB ^GELOW, M. D. 

PBTSICIAS A!n> LICTURKR ON CLITHCAL mOICIITK IH THS MASSACflUSXm 
OB NKRAL. HOSPITAL ; PBOrB-:SOB OV MATERIA II KDIC A IN HARTA:<0 

usiTBRSirr; pkbsidbnt or thi americah acadbiit or 

ARTS AXD 8CIBXCBS } AND LATB PKRSIDnrr Or 
THB MA88ACHCSBTTS MBOICAL 80CIKTT. 



BOSTON: 
TICKNOR AND FIELDS. 

M DCCC L],V« 



l^ATURE IN DISEASE, 



ILLUSTRATED IN 



VARIOUS DISCOURSES AND ESSAYS. 



TO WHICH ARE ADDED 



MISCELLANEOUS WRITINGS, 



CHIEFLY ON MEDICAL SUBJECTS. 



BY JACOB ^GELOW, M. T>. 

PHTSICIAJr AXD LSCTURBR ON CLIXICAL 1IEJ)ICINB IS THB MASSACSrSETTS 
GENERAL. HOSPITAL ; PROFESSOR OV MATERIA MKDIC A IN HARVA:<0 

UNiFBRSirr; pkesidbkt of the American academy of 

ARTS AND SCIEXCBS } AND LATE PKKSIDKNT OF 
THE MASSACHCSBTTS MEDICAL SOCIETY. 



BOSTON: 
TICKNOR AND FIELDS, 

M DCCC L],V« 



K)\.c^ Z.&^.^. 10 



Entered according to Act of Congress, in the year 1854, by 

TICXNOR AND FIELDS, 

In the Clerk's Offloe of the District Court of the District of Massachiuetts. 



HAirVARD COLLEGE LIBRARt 



BOSTO Vt 
TBC&3T0H AHO TOBBr, TBIMTBRS 



PREFACE. 

It is observable to many physicians, that a change in the 
mode of regarding the treatment of disease has come over 
the medical world in this city and in varioas parts of the 
United States, during the last quarter of a century. In 
certain cases a practice of watching, guiding, and trusting 
the salutary indications of nature, has taken the place of 
more active interferences of art. Those men whose medical 
career began at a period antecedent to that which has been 
named, will recollect that the course then most prevalent 
among the profession consisted in energetic and sometimes 
annoying and painful applications of supposed remedies, 
from the beginning to the end of diseases, whether those 
diseases were amenable to such treatment, or totally incapa- 
ble of being influenced by them. And, in some instances, 
such active measures were promoted by influential teachers 
of medical science, in the great schools of our country. 

Nearly twenty years ago, the Discourse on Self-limited 
Diseases^ which stands at the head of this volume, was de- 



IV PREFACE. 

livered before the Massachusetts Medical Society, at their 
annual meeting, as an expression of opinions I had been led 
to entertain, as to the influence of treatment on the event 
of some morbid affections. Subsequent observation has not 
tended to shake these opinions ; and I have had the satisfac- 
tion to believe that many of my medical friends, for whose 
judgment the public entertain the highest respect, have ar- 
rived at similar conclusions. As science has advanced, some 
revision has become necessary of this as well as of some 
other essays written, long ago. But the general truth of the 
positions then assumed has not been contradicted by later 
experience of competent observers in the profession. * 

The exclusive pursuit of any profession frequently tends 
to an undue exaggeration of its powers. What we have 
been early taught to accept on authority, and what we have 
been accustomed habitually to announce to others, may be- 
come engrafted on our own belief, so as to Constitute an 
unquestioned rule of practice. The necessity is, on this 
account, more imperative, that inquirers for truth should 
divest themselves of personal considerations, and seek for 
rules of practice which are based on enlightened experience, 
and impartial and reliable evidence. 

I have given the title ** Nature in Disease** to the present 
collection of discourses and disquisitions, because a number 
of the principal articles in its contents bear directly on that 



PREAFCE. V 

subject. But I have taken advantage of the same occasion 
to incorporate in this small volume some other miscellaneous 
papers, chiefly on medical subjects, written or published at 
various times, during a long and active professional life. 

J. B. 

Boston, Nov. 1, 1854. 



ERRATA. 

Page 3, line 8 from top, for giye, read gives. 

" 19, " 5 from bottom, " III. 616, «* I. 65!. 

*« 79, " 10 from top, " affctions, ** aflTections. 
«« 235, «* 6 from bottom, " Grat Britain, «' Great Britain. 
" 235, " 3 »* " *♦ do novo, »* de novo. 



CONTENTS. 

^' Page 

On Self-limited Diseases 1 

II. 
On the Treatment of Disease .... 59 

III. 
Practical Views of Medical Education • .91 

IV. 

Report on Homceopatht • • . • .101 

V, 

On the Medical Profession, and Quackery . .110 

VI. 

Oh Gout and its Treatment . . • .132 

VII. 
On the Treatment ob Injuries occasioned by Fire 

AND Heated Substances . • • .146 

VIII. 
On the Burial of the Dead ; and the Cemetery 

AT Mount Auburn 171 

IX. 
Remarks and Experiments on Pneumothorax . 195 



Vm CONTENTS. 

X. 

On tub Pharmacop(eia of the United States . 231 

XL 
On the Mucuna Pruriens : with Remarks on the 

Irritability of different Textures . . 866 

XII. 
On the Poisonous Effects of the American Par- 
tridge, OR Ruffed Grouse .... 272 

XIII. . 
On Coffee and Tea ; and their Medicinal Effects 289 

XIV. 
Report on the Action of Cochituate Water on 
Lead Pipes; and the Influence of the same 
on Health ...*... 315 

XV. 

On the History and Use of Tobacco . . .323 

XVI. 
On the Early History of Medicine . . . 337 

xvn. 

Address delivered before the American Academy 
of Arts and Sciences, at the opening of their 
Course of Lectures, October 27, 1S52. . 358 



ON 



SELF-LIMITED DISEASES: 

A DISCOURSE DELIVERED BEFORE THE MASSACHUSETTS 

medical society, at their annual meeting, mat 
27th, 1835. 

[At the beginning of this discourse, the eustomary obituary 
notice was taken of eminent members of the society, de- 
ceased during the previous year.] 

The death of medical men is an occurrence 
which eminently demands our attention, for it 
speaks to us of our science, and of ourselves. 
It reminds us, that we, in turn, are to become 
victims of the incompetency of our own art. It 
admonishes us, that the sphere of our profession- 
al exertions is limited, at last, by insurmount- 
able barriers. It brings with it the humiliating 
conclusion, that while other sciences have been 
carried forward, within our own time and al- 
most under our own eyes, to a degree of un- 
precedented advancement. Medicine, in regard 
1 



Z SELF-LIMITED DISEASES. 

to some of its professed and most important 
objects, is still an ineffectual speculation. Ob- 
servations are multiplied, but the observers dis- 
appear, and leave their task unfinished. We 
have seen the maturity of age, and the ardent 
purpose of youth, called off from the half cul- 
tivated field of their labors, expectations and 
promise. It becomes us to look upon this deep- 
ly interesting subject with unprejudiced eyes, 
and to endeavor to elicit useful truth from the 
great lesson that surrounds us. 

In comparing the advances which have been 
made, during the present age, in different de- 
partments of Medical science, we are brought to 
the conclusion, that they have not all been cul- 
tivated with equally satisfactory success. Some 
of them have received new and important illus- 
trations from scientific inquiry, but others are 
still surrounded with their original difficulties. 
The structure and functions of the hujnan body, 
the laws which govern the progress of its dis* 
eases, and more especially the diagnosis of its 
morbid conditions, are better understood now, 
than they were at the beginning of the present 
century. But the science of therapeutics, or the 



SELF-LIMITED DISEASES. 6 

branch of knowledge by the application of which 
physicians are expected to remove diseases, has 
not, seemingly, attained to a much more eleva- 
ted standing than it formerly possessed. The 
records of mortality attest its frequent failures, 
and the inability to control the event of diseases, 
which at times is felt by the most gifted and 
experienced practitioners, give^ evidence that, 
in many cases, disease is more easily under- 
stood, than cured. 

This deficiency of the healing art is not justly 
attributable to any want of sagacity or diligence 
on the part of the medical profession. It be- 
longs rather to the inherent diflSculties of the 
case, and is, after abating the effect of errors and 
accidents, to be ascribed to the apparent fact, 
that certain morbid processes in the human 
body have a definite and necessary career, from 
which they are not to be diverted by any known 
agents, with which it is in our power to oppose 
them. To these morbid affections, the duration 
of which, and frequently the event also, are 
beyond the control of our present remedial 
means, I have, on the present occasion, applied 
the name of Self-limited diseases ; and it will 



4 SELF-LIMITED DISEASES. 

be the object of this discourse to endeavor to 
show the existence of such a class, and to in- 
quire how far certain individual diseases may 
be considered as belonging to it 

By a self-limited disease, I would be under- 
stood to express one which receives limits from 
its own nature, and not from foreign influences ; 
one which, after it has obtairied foothold in the 
system, cannot, in the present state of our know- 
ledge, be eradicated, or abridged, by art, — but 
to which there is due a certain succession of 
processes, to be completed in a certain time ; 
which time and processes may vary with the 
constitution and condition of the patient, and 
may tend to death, or to recovery, but are not 
known to be shortened, or greatly changed, by 
medical treatment. 

These expressions are not intended to apply 
to the palliation of diseases, for he who turns a 
pillow, or administers a seasonable draught of 
water to a patient, palliates his sufferings ; but 
they apply to the more important consideration 
pf removing diseases themselves through medi- 
cal means. 

The existence of a class ot diseases, like those 



SELF-LIMITED DISEASES. D 

nnder consideration,' is, to a certain extent, 
already admitted, both by the profession, and 
the public ; and this admission is evinced by the 
use of certain familiar terms of expression. 
Thus, when people speak of a ' settled disease,' 
or of the time of *the run of a disease,' it implies, 
on their part, a recognition of the law, that 
certain diseases regulate their own limits and 
period of continuance. 

It is difficult to select a perfectly satisfactory 
or convincing example of a self-limited disease 
from among the graver morbid affections, be- 
cause in these affections the solicitude of the 
practitioner usually leads him to the employ- 
ment of remedies, in consequence of which, the 
effect of remedies is mixed up with the phenom- 
ena of disease, so that the mind has difficulty in 
separating them. [Note A.] We must there- 
fore seek for our most striking or decisive exam- 
ples among those diseases which are sufficiently 
mild, not to be thought to require ordinarily the 
use of remedies, and in which the natural his- 
tory of the disease may be observed, divested of 
foreign influences. Such examples are found 
in the vaccine disease, the chicken pox, and the 



6 SELF-LIMITED DISEASES. 

salivation produced by mercury. These are 
strictly self-limited diseases, having their own 
rise, climax, and decline ; and I know of no 
medical practice which is able, were it deemed 
necessary, to divert them from their appropriate 
course, or hasten their termination. [Note B.] 

It may appear to some, that the distinction of 
these diseases from others, is the old distinction 
of acute and chronic. Yet on due inquiry, such 
an identification is not found to be sustained, 
for there are some acute diseases which, we 
have reason to believe, are shortened by the 
employment of remedies; while, on the other 
hand, certain chronic cases of disease are known 
to get well spontaneously, after years of con- 
tinuance. 

If the inquiry be made, why one disease has 
necessary limits, while another is without them ? 
the reply is not uniform, nor always easy to be 
made. Sometimes the law of the disease may 
be traced to the nature of the exciting cause. 
Thus the morbid poison of measles, or of small 
pox, when received into the body, produces a 
self-limited disease ; but the morbid poisons of 
psora and syphilis may give rise to others which 



SELF-LIMITED DISEASES. 7 

are not limited, except by medical treatment. 
[Note C] Sometimes, also, the cause being 
the same, the result will depend on the part, 
organ, or texture which is affected. Thus if we 
divide with a cutting instrument the cellular or 
muscular substance, we produce a self-limited 
disease, which, although it cannot by any art be 
healed within a certain number of days or 
weeks, yet in the end gets well spontaneously, by 
one process, if the lips are in contact, — and by 
another and slower process, if they are separa- 
ted.* But if, on the other hand, we divide a 
considerable artery, we have then an unlimited 
disease ; and the hemorrhage, or the aneurism, 
which follows, does not get well, except through 
the interposition of art. 

The class of diseases under consideration, 
comprehends morbid affections, differing greatly 
from each other, in the time, place, and nature 
of their spontaneous developments ; so that 
they may admit of at least three general 
subdivisions. These may be called, 1st. The 
simple; in which the disease observes a con- 

* In one case, the disease is a solution of continuity ; in the 
other, a solution of continuity and contact. 



8 SELF-LIMITED DISEASES. 

tinaous time, and mostly a definite seat; 2d, 
The paroxysmal; in which the disease, having 
apparently disappeared, returns at its own 
periods ; and 3d. The metastatic ; in which the 
disease undergoes metastasis or spontaneous 
change of place. In the present state of our 
knowledge, we have no difficulty in finding 
examples of each of these subdivisions. There 
are also other examples, in which the disease, 
although capable of being in part influenced by 
medical treatment, still retains a portion of its 
original intractability, and has strong relations 
to the class in question. 

As a mode of directing our inquiries toward 
these diseases, we may suspect those complaints 
to be self-limited, in which it is observed that 
the unwary, and the sceptical, who neglect to 
resort to remedies, recover their health without 
them. We may also suspect diseases to be of 
this character, when we find opposite modes 
of treatment recommended, and their success 
vouched for, by practitioners of authority and 
veracity. We may moreover attach the same 
suspicion to cases, in which the supposed cure 
takes place under chance applications, or incon- 



0ELF-LIMITED DISEASES. 9 

siderable remedies; as in the empirical modes 
of practice on the one hand, and the minute 
doses of the homoeopathic method on the other. 
Lastly, we may apprehend that cases are fatally 
self-limited,* when enlightened physicians die 
themselves of the diseases which they had la- 
bored to illustrate, — as in the case of Corvisart, 
Laennec, Armstrong, and others. [Note D.] 

In proceeding to enumerate more precisely 
some of the diseases which appear to me to be 
self-limited in their character, I approach the 
subject with diffidence. I am aware that the 
works of medical writers, and especially of 
medical compilers, teem with remedies and 
modes of treatment for all diseases; and that 
in the morbid affections of which we speak, 
remedies are often urged with zeal and con- 
fidence, even though sometimes of an opposite 
character. Moreover, in many places, at the 
present day, a charm is popularly attached to 
what is called an active, bold, or heroic prac- 

* In the following article on the Treatment of Disease, it has 
been found convenient to divide diseases into the curable, the 
self-limited, and the incurable. In a general sense, however, 
the last term fallB within the second. 



10 SELF-LIMITED DISEASES. 

tice; and a corresponding reproach awaits the 
opposite course, which is cautious, palliative, 
and expectant. In regard to the diseases which 
have been called self-limited, I would not be 
understood to deny that remedies capable of 
removing them may exist ; I would only assert, 
that they have not yet been proved to exist. 

Under the simple self-limited diseases, we 
may class hoopinff cottgh. This disease has its 
regular increase, height, and decline, occupying 
ordinarily from one to six months, but in some 
mild cases only two or three weeks. During 
this period, medical treatment is for the most 
part of no avail. Narcotic appliances may 
diminish the paroxysm, but without abridging 
the disease. After hooping cough has reached 
its climax, change of air sometimes appears to 
hasten convalescence. Also if inflammatory, 
or other morbid affections, supervene upon the 
pure disease, they may become subjects for 
medical treatment. With these exceptions, 
hooping cough appears to be a self-limited 
disease. 

Most of the class of diseases usually de- 
nominated eruptive fevers, are self-limited. 



SELF-LIMITED DISEASES. 11 

Measles, for example, is never known to be 
cut short by art, or abridged of its natural 
career; neither can this career be extended or 
the disease kept in the system beyond its 
natural duration, by the power of medicine. 
Scarlet fever, a disease of which we have had 
much and fatal experience during the last three 
years, is eminently of the same character. The 
reasons, which induce me thus to regard it, 
are the following. The writings of medical 
observers agree in assigning to it a common, 
or average period of duration, and this is con- 
firmed by the observations of practitioners at 
the present day. From this average duration 
and character there are great natural deviations, 
the disease being sometimes so slight, as to 
attract the notice of none but medical eyes, 
and sometimes so malignant, that treatment is 
admitted to be hopeless. The modes of treat- 
ment, which have had most testimony in their 
favor, are various, and opposite. By Dr. Fother- 
gill, stimulants were relied on ; by Dr. Currie, 
cold water ; by Dr. Southwood Smith, and 
others, blood letting. But it is not satisfactorily 
shown, that either of these modes of practice 



12 SELF-LIMITED DISEASES, 

ihas been particularly successful ; for where the 
writers have furnished us anything like definite, 
or numerical results, it does not appear that the 
mortality was less in their hands than it is 
among those who pursue a more expectant' 
practice. The post mortuary appearances, which 
in many diseases furnish useful lessons for prac- 
tice, are in scarlet fever extremely various and 
uncertain; and sometimes no morbid changes, 
sufiicient to account for death, can be discovered 
in any of the vital organs, or great cavities. 
JNote E.] 

Small Pox is another example of the class of 
affections under consideration, its approach and 
-disacppearance being irrespective of medical 
practice. It may, at first view, appear, that 
inoculation has placed artificial limits on this 
disease. But it must be recollected, that inocu- 
lated small pox is itself only a milder variety 
of the same disease, having its own customary 
limits of extent and duration, which are fixed, 
quite as much as those of the distinct and con- 
fluent forms of the natural disease. 

Erysipelas is an eruptive fever, having strong 
tinalogies with those which have been detailed. 



SELF-LIMITED DISEASES. . 13 

It is not certain, that art can very materially 
affect either the duration or the extent of this 
malady. If a physician is called to a case of 
erysipelas, which is beginning to be developed 
upon a part of the face ; and if he is asked, 
whether ihe disease will extend to the crown, or 
the neck, or to the right ear, or the left, — he 
cannot tell. And if he is asked to prevent it 
from visiting either of these places, I know of 
no satisfactory evidence that he can do it. 
Erysipelas,' however, in a great number of sim- 
ple, or exanthematous cases, in subjects previ- 
ously healthy, gets well without any treatment J 
and in a great number of deep-seated and 
phlegmonous cases, as well as those in which 
vital organs are affected, it proves fatal under 
the most approved methods of medical and 
surgical practice. It is true, that patients have 
recovered, under punctures, incisions, and cau- 
tery. It is also true, that they have died under 
the same operations, so that it may be submit- 
ted as a doubtful point, whether we yet possess 
adequate evidence, that erysipelas is not also a 
self-limited disease. 

It is a question of great interest to the medi- 



14 SELF-LIMITED DISEASES. 

cal profession, to determine whether typhoid 
fever is a disease susceptible of control from 
medical means. On this subject no one now 
doubts, that if the disease is once fairly estab- 
lished in the system, it cannot be eradicated by 
art, but must complete a certain natural course, 
before convalescence can take place. But a 
question still exists, whether this disease is 
capable of being jugulated, or broken up, at its 
outset, by the early application of remedies. 

It must be allowed, that attacks' of disease 
resembling those of typhoid, sometimes speedily 
disappear during the use of remedies ; but it is 
by no means certain that such cases are actually 
cases of typhoid. The diagnosis of this disease, 
during the first day or two, is extremely diffi- 
cult, its character being similated by different 
febrile and inflammatory affections ; so that if a 
patient, under the use of remedies, succeeds in 
avoiding protracted disease, we are not justified 
in saying, that the disease he has escaped was 
typhoid or typhous fever. Andral, whose ex- 
periments on the different modes of treatment in 
continued fever, are very extensive, has stated, 
that in a number of cases, observed by him, in 



SELF-LIMITED DISEASES. 15 

which the fever was suiEciently intense, the dis- 
ease ceased in twenty-four or forty-eight hours, 
without any treatment, except that of rest and 
a regulated diet.* 

Moreover, in weighing the influence of treat- 
ment, it ought to be recollected, that during the 
existence of any prevailing epidemic, mild cases, 
partaking of a similar character to that of the 
reigning disease, continually appear among the 
less susceptible part of the community. Thus 
cholera is attended by diarrhoea or cholerine, 
influenza by mild catarrh, small pox by varioloid, 
scarlet fever by slight sore throats or ephemeral 
eruptions, &c. Now, although these cases are 
in reality modified examples of the grave dis- 
eases which they accompany, yet I believe that 
no well-informed physician will attribute the 
mildness or shortness of their character to his 
own particular practice. 

On the other hand, it is certain that cases of 
real typhoid do often come under active treat- 
ment at an early stage, without being broken 
np, or disarmed of their appropriate conse- 

• Clinique III. 619. 



16 SELF-LIMITED DISEASES.; 

quences. This particularly happens, when the 
disease is endemic in families, so that succes- 
sive cases begin, as it were, under the eye of the 
attending physician, who has every possible 
inducement to detect and prevent them, if he 
can. In such families, indeed, it will sometimes 
happen, that febrile attacks of different kinds, 
consequent upon fatigue and anxiety, and per- 
haps partaking of the typhoid character, will 
take place among the friends and attendants of 
the sick ; and these may disappear speedily, 
under rest and evacuations. But that grave 
and specific typhoid fever will thus disappear, is 
a point of which we as yet want proof. That 
it sometimes fails to disappear, we have abun- 
dant proof. 

Typhoid fever has, in many respects, a mark- 
ed affinity with the class of eruptive fevers, 
which are supposed to depend on a si>ecifio 
morbid poison, and which no one pretends to 
intercept, after the body has become infected 
with them. Scarlet fever and measles, for ex- 
ample, when once established, require a certain 
number of days to finish their course ; so also 
does the typhoid. Scarlet fever and measles 



SELF-LIMITED DISEASES. 17 

can, in most cases, be had but once daring life ; 
but to this general rule there are exceptions. 
The same is precisely true in regard to typhoid. 
The contagiousness of scarlet fever is a point 
of dispute among physicians; and so is that 
of typhoid. Scarlet fever is attended by an 
eruption on the skin. Typhoid fever also has 
for one of its most constant symptoms a red, 
lenticular eruption, consisting of a few scatter- 
ed rose-colored pimples, appearing chiefly on 
the trunk, from about the sixth to the nineteenth 
day of the disease. There also occurs, in most 
subjects, a minute, vesicular eruption of sudcL- 
minaj about the neck and elsewhere. In scarlet 
fever, moreover, certain portions of the mucous 
membrane undergo morbid alterations, particu- 
larly on the tonsils, and other parts of the 
fauces, and these frequently degenerate into 
ulcers, affecting the subjacent textures. In like 
manner, in typhoid fever, the mucous membrane 
of the glandular patches in the small intestines, 
which have been named after the anatomist 
Peyer, undergo morbid changes, and these 
changes are followed by ulcerations, and some- 
times perforations of the intestine. This fact, 
2 



18 SELF-LIMITED DISEASES. 

established by the researches of Louis and other 
pathologists in Paris, has been abundantly con- 
firmed by post mortem examinations made in 
this country during the last few years.* If it 
be objected to the proposed classification of this 
fever, that the taches are sometimes few in 
number, or wholly absent: it is equally true, 
that the pustules of inoculated small pox are 
likiewise often very few, or absent ; and that the 
eruption of scarlatina sometimes wholly fails to 
appear. The sore throat also in the latter dis- 
ease is wanting, quite as often, to say the least, 
as the morbid affection of Peyer's glands. 

Before quitting the subject, I beg leave to 
introduce the opinion of one or two medical 
writers, in regard to the possibility of interrupt- 
ing or breaking up this disease by means of art. 
M. Louis, of whose researches in regard to 
typhoid fever, it is but small praise to say, that 
they are more exact and comprehensive than 
those of any living writer, is of opinion that the 
disease cannot be thus intercepted. * Experi- 
ence,' says he, * has shown, that a well marked 
typhoid affection is not capable of being broken 
♦ 1835. 



SELF-LIMITED DISEASES. 19 

up.'* To this testimony of one of the most 
eminent teachers in the French metropolis, it 
may not be amiss to add that of an American 
physician, whose opportunities for observing the 
disease in different parts of New England were 
extensive, and whose Essay on Typhus Fever 
well merits an attentive perusal. The late Dr.. 
Nathan Smith, in the course of some remarks 
on the possibility of interrupting this disease at 
commencement, observes: * During the whole of 
my practice I have never been satisfied that I 
have cut short a single case of typhus, that I 
knew to be such.' f 

* * L^experience ayant montr6, que Paffeotion typhoide bien 
caract^risee, n'est pas susceptible d'etre jugul6e, ce qui n'est: 
guere moins yrai, d'ailleurs, suiTant toutes les apparences, de 
la peripneumonie et des autres maladies inflammatoires.' — 
Louis, Gastro-enteriU, IT. 612. 

Andral says, in regard to the different modes of treatment in 
typhus, ' Quelles que soient les methodes employees, il est un 
certain nombre de oas oi!l, sans que ces methodes y prennent part,. 
la nature conduit la maladie k nne terminaison heureuse ou. 
foneste. •— Clinique III. 616, 617. 

t At the time of the publication alluded to, the distinction be-^ 
tween typhus and typhoid feyers had not been well made out 
The distinction is good, though writers of authority differ on the 
subject 



20 SELF-LIMITED DISEASES. 

Having said thus much, I leave the subject of 
the tractability of typhus and typhoid fever to 
the light of future investigation. It is but 
Justice to state, that numerous and highly 
respectable authorities are declared in favor of 
i;he efficacy of art in shortening and mitigating 
iihese diseases ; and it will be a source of 
gratification to the friends of humanity and 
science, should it ultimately be settled, that 
the active treatment now usually pursued at 
the commencement of cases, is instrumental 
in lessening their duration, severity, or dan- 
ger. 

Among the morbid affections which have 
now been enumerated, may be found sufficient 
examples of continued diseases, which receive 
limits from their own nature, and not from the 
interference of art. Whether the number of 
these diseases may not be augmented by ad- 
<litions from among other fevers, and acute 
inflammations, I am not prepared to decide. It 
is difficult, however, to withhold the belief, that 
a more extended inquiry must probably serve to 
multiply, rather than diminish, the number of 



3ELF-LIMITED DISEASES. 21 

maladies to which. this character will be found 
appropriate.* 

We come next to a second order of self- 
limited diseases, of which the term paroxysmal 
is sufficiently descriptive. This term applies to 
certain morbid affections, which recur in fits or 
paroxysms, leaving the patient comparatively 
well in the intervals, at the same time that the 
paroxysms themselves can neither be foreseen, 
prevented, nor, as far as we know, materially 
abridged in their duration. At the head of this 
Bubdivision stands Epilepsy^ a disease which 
has •long been eminent as an opprobrium of 
medicine, and for which, it is believed, the 
healing art has not yet devised a cure. The 
first attacks of epilepsy, especially while there is 
uny doubt as to the nature of the malady, are 
usually made the subjects of active and various 
treatment But after the recurring paroxysms 
have established the character of the disease, if 

* There is not room here to disoass the question whether 
Pneumonia and other acute inflammations fall under the category 
of self-limitation. Blood-letting, in proper cases, lessens the 
•ererity and danger of these diseases. But it is not apparent 
that it greatly abridges their duration. I)7sentery may be 
aoooonted a self-limited disease. 



22 SELF-LIMITED DISEASES. 

active medical practice is persevered in, it is 
rather to satisfy the anxiety of friends, than the 
judgment of the practitioner. 

Angina pectoris^ appropriately called by Dr. 
Good, Sternalgia, is a paroxysmal disease, which 
in many cases controls its own movements. 
The anatomical character of this disease is not 
uniform, and I may add, the same is true of its 
medical treatment. And in this place it may 
be proper to state, that various incurable lesions 
of the heart, lungs, brain, and other viscera, 
do not apparently destroy life by a regular, 
undeviating march ; but that as far as their 
outward phenomena aflford evidence, they seem 
to proceed by alternate fits and pauses, under- 
going, in their progress, all states, except that 
of retrogradation. This is apparently true» 
in regard to tubercle, carcinoma, ossification, 
hypertrophy, and some other morbid alterations. 
It is also even true in regard to old age itself. 

Thirty years ago, we might have added gout 
to the opprobrious list under consideration. But 
as we may now be said to possess the means of 
shortening the paroxysms, by the use of certain 
acrid narcotics ; and as an abstemious life goes 



SELF-LIMITED DISEASES. 23 

far towards lessening the frequency and violence 
of the recurrence, we may be justified in with- 
drawing gout from the place it would otherwise 
occupy. [Note F.] 

The diseases of mania and melancholy, 
asthma, when it depends on emphysema of the 
lungs, gravel in the kidneys, and the symptoms 
produced by»ascarides in the rectum, [Note G], 
furnish other examples of maladies, which 
manifest themselves ^ in unforeseen paroxysms. 
Cases, which bear the names of all the above 
diseases, are undoubtedly relieved, and some- 
times even removed by medicine ; but it is 
equally true, that other cases are wholly in- 
tractable, both as to their recurrence, their 
duration, and their susceptibility of much 
change from medical treatment. And it will 
come to the recollection of many practitioners, 
that they have, in the course erf their lives, 
believed themselves to have cured these dis- 
eases, when in fact 1:hey have only witnessed 
the spontaneous subsidence of a paroxysm. 

The last subdivision of our subject includes 
what may be called metastatic diseases. By 
this term I wish to express certain morbid 



24 SELF-LIMITED DISEASES. 

affections, which pass by metastasis from one 
part of the body to another, for the most part 
independently of artificial influence. Of this 
kind are certain cutaneous aflections, more espe- 
cially some which are chronic and hereditary. 
Many persons pass a considerable portion of 
their lives in alternate annoyance from a 
disease of the skin, and from 4ts vicarious 
substitute in some internal organ. Others 
again are afilicted with hemorrhagic, or puru- 
lent discharges^ which at times disappear, only 
to be succeeded by equally troublesome affec- 
tions in a different part. Gonorrhasa cannot 
be prevented from occasional metastasis of 
inflammation, and mumps are sometimes found 
to undergo the same transition. But perhaps 
the most remarkable example of a metastatic 
disease is found in acute rheumatism. This 
morbid affection often begins to discover itself 
in a limited and comparatively unimportant 
part of the system. From thence, in grave 
cases, it travels by successive migrations from 
joint to joint, and from limb to limb, till it has 
visited nearly all the great articulations of the 
body. It also attacks the organs of sense, and 



SELF-LIMITED DISEASES. 25 

the viscera which are essential to life. During 
the course of these migrations, the attending 
physician cannot foretell at any given stage, 
what part will be next invaded by the disease, 
neither can he protect any part from being thus 
invaded ; nor can he control the period, during 
which the disease will reside in any particular 
part previously to its next metastasis. Never- 
theless acute rheumatism is susceptible of great 
palliation though of little abridgment, and 
after having run out its career, terminates in 
spontaneous recovery; not, however, in some 
cases, until it has laid the foundation of serious 
organic derangements, especially of the heart. 

I forbear to dilate on the structural lesions of 
different organs, many of which can only be 
cured by the extirpation of the part in which 
they reside, thus sacrificing the integrity of the 
body to the preservation of life ; and in which 
extirpation cannot avail, when the seat of the 
disease is in a vited part I also pass over the 
pestilential epidemics of plague, yellow fever, 
malignant dysentery and cholera ; diseases 
about which the medical profession have great 
differences of opinion, and of which thousands 



26 SELF-LIMITED DISEASES. 

die annually, though hundreds of volumes have, 
been written for their preservation. [Note H.] 

It may perhaps appear that the views which 
have now been taken of the power of medicine, 
in so large a class of diseases, are gloomy and 
discouraging, and that an unworthy tribute is 
paid to the labors of those physicians, who have 
patiently studied, and ardently acted, for the 
benefit of humanity. Such views, however, are 
far from being the object of the present dis- 
course. Were it permitted by the compass of 
the subject under consideration, it would be a 
very grateful task to enumerate those maladies 
of the human frame, over which we have reason 
to believe that medicine has obtained decisive 
influence. To a medical audience, it is un- 
necessary to recall the instances of pain reliev- 
ed, spasms controlled, inflammations checked, 
[Note I], and diseased associations broken up, 
under limitable diseases, by the agency of the 
healing art. Were there no other trophy for the 
medical profession to boast, it is sufficient to 
know, that the diseases of small pox and syphi- 
lis alone would have entailed misery and exter- 
mination on a large portion of our species, had 



SELF-LIMITED DISEASES. 27 

not medical science discovered the prevention 
of the one, and the successful management of 
the other. 

But that the usefulnops gf our profession may 
extend, our knowledge must go on to increase ; 
and the foundation of all knowledge is truth. 
For truth then we must earnestly seek, even 
when its developments do not flatter our pro- 
fessioncd pride, nor attest the infallibility of our 
art To discover truth in science, is often ex- 
tremely difficult ; in no science is it more diffi- 
cult than in medicine. Independently of the 
common defects of medical evidence, our self- 
interest, our self-esteem, and sometimes even 
our feelings of humanity, may be arrayed 
against the truth. It is difficult to view the 
operations of nature, divested of the interfer- 
ences of art, so much do our habits and partial- 
ities incline us to neglect the former, and to 
exaggerate the importance of the fatter. The 
mass of medical testimony is always on the side 
of art Medical books are prompt to point out 
the cure of diseases. Medical journals are filled 
with the crude productions of aspirants to the 
cure of diseases. Medical schools find it incum- 



28 SELF-LIMITED DISEASES. 

bent on them to teach the cure of diseases. 
The young student goes forth into the world, 
believing that if he does not cure diseases, it is 
his own fault Yet when a score or two of 
years have passed over his head, he will come 
at length to the conviction; that some diseases 
are controlled by nature alone. He will often 
pause at the end of a long and anxious attend- 
ance, and ask himself, how far the result of the 
case is different from what it would have been 
under less officious treatment, than that which 
he has pursued ; how many in the accumulated 
array of remedies, which have supplanted each 
other in the patient's chamber, have actually 
been instrumental in doing him any good. He 
will also ask himself whether, in the course of 
his life, he has not had occasion to change his 
opinion, perhaps more than once, in regard to 
the management of the disease in question, and 
whether he does not, even now, feel the want of 
additional light. 

Medicine has been rightly called a conjectural 
art, because in many of its deductions, and es- 
pecially in those which relate to the cure of 
diseases, positive evidence is denied to us. We 



SELF-LIMITED DISEASES^ 29 

are seldom justified in concluding that our 
remedies have promoted the cure of a disease, 
until we know that cases exactly similar in 
time, place, and circumstances, have failed to do 
equally well under the omission of those reme- 
dies ; and such cases, moreover, must exist in 
sufficient numbers to justify the admission of a 
general law, on their basis. Nothing can be 
more illogical, than to draw our general conclu- 
sions, as we are sometimes too apt to do, from 
the results of insulated and remarkable cases ; 
for such cases may be found in support of any 
extravagance in medicine ; and if there is any 
point in which the vulgar differ from the judi- 
cious part of the profession, it is in drawing 
premature and sweeping conclusions, from 
scanty premises of this kind. Moreover, it is 
in many cases not less illogiced to attribute the 
removal of diseases, or even of their troublesome 
symptoms, to the means which have been most 
recently employed. It is a common error to 
infer that things which are consecutive in the 
order of time, have necessarily the relation to 
cause and effect. It often happens that the last 
remedy used, bears off the credit of having re« 



30 smiT^himrrmD dissasbs. 

moved an obstnictioo,CNr cored a disease, wheieas 
in fact the residt may hare been owing to the 
first remedy employed, <wr to the joint eflect of 
all the remedies, or to the act of nature, nnin- 
fluenced by any of the remedies. We see 
this remarkably exemjdified in recoveries from 
amenorrhoea, and from various irr^nlarities of 
the alimentary canaL 

An inherent difficulty, which every medical 
man finds to stand in the way of an unbiased 
and satisfactory judgment, is the heavy respon- 
sibility which rests upon the issue of his cases. 
When a friend, or valuable patient, is commit- 
ted to our charge, we cannot stand by, as curi- 
ous spectators, to study the natural history of 
his disease. We feel that we are called on to 
attempt his rescue by vigorous means, so that 
at least the fault of omission shall not lie upon 
our charge. We proceed to put in practice 
those measures, which on the whole have ap- 
peared to us to do most good ; and if these fail 
us, we resort to other measures, which we have 
read of, or heard of. And at the end of our 
attendance we may be left in uncertainty, 
whether the duration of sickness has been 



SELF-LIMITED DISEASES. 31 

shortened, or lengthened, by our practice, and 
whether the patient is realJy indebted to ud for 
good or evil. In the study of experimental 
philosophy, we rarely admit a conclusion to be 
true, until its opposite has been proved to be 
untrue. But in medicine we are often obliged 
to be content to accept as evidence the results 
of cases, which have been finished under treat- 
ment, because we have not the opportunity to 
know how far these results would have been 
different, had the cases been left to themselves. 
And it too frequently happens, that medical 
books do not relieve our difficulties on this score, 
for a great deal of our practical literature con- 
sists in reports of interesting, extraordinary, and 
successful results, published by men who have 
a doctrine to establish, or a reputation to build. 
* Few authors,' says Andral, ' have published all 
the cases they have observed, and the greater 
part have only taken the trouble to present to 
us those facts which favor their own views.' * 
A prevailing error among writers on therapeu- 

* Bien pen d'anteors ont public tons les cas qu'ils ont ob- 
serr^s, et la plnpart ne se sont empresses de nous transmettre ' 
que les fiuts que caressident lears id^es. — CHnigue III. 618. 



82 SELF-LIMITED DISEASES. 

tics, proceeds from their professional, or personal 
reluctance to admit that the healing art, as 
practised by them, is not, or may not be, all 
sufficient, in all cases ; so that on this subject 
they suffer themselves, as well as their readers, 
to be deceived. Hence we have no disease, 
however intractable or fatal, for which the press 
has not poured forth its asserted remedies. 
Even of late, we have seen unfailing cures of 
cholera successively announced in almost every 
city, in which that pestilence unchecked has 
completed its work of devastation ! 

It is only when, in connection with these flat- 
tering exhibitions, we have a full and faithful 
report of the failures of medical practice, in 
similar, and in common cases, setting forth not 
only the truth, but the whole truth, that we 
have a basis sufficiently broad to erect a super- 
structure in therapeutics, on which dependence 
may be placed. Such, it must give the friends 
of science gratification to observe, is a part of 
the rigid method which characterizes the best 
examples of the modern French school; and 
such, it id not difficult to foresee, must ultimate- 
ly be the only species of evidence on this sub- 



SELF-LIMITED DISEASES. 33 

ject, to which the medical profession will pay 
deference. ^ 

It appears to me to be one of the most im- 
portant desiderata in practical medicine, to 
ascertain, in regard to each doubtful disease, 
how far its cases are really self-limited, and how 
far they are controllable by any treatment. 
This question can be satisfactorily settled only 
by instituting, in a large number of cases, 
which are well identified and nearly similar, a 
fair experimental comparison of the different 
active and expectant modes of practice, with 
their varieties in regard to time, order, and 
degree. This experiment is vast, considering 
the number of combinations which it must in- 
volve; and even much more extensive than a 
.corresponding series of pathological observa- 
tions ; yet every honest and intelligent observer 
may contribute to it his mite. Opportunities 
for such observations, and especially for mono- 
graphs of diseases, are found in the practice of 
most physicians, yet hospitals and other public 
charities afford the most appropriate field for 
instituting them upon a large scale. The ag- 
gregate of results, successful and unsuccessful. 



34 SELF-LIMITED DISEASES. 

circumstantially and impartially reported by 
competent observers, will give us a near approx- 
imation to truth, in regard to the diseases of the 
time and place, in which the experiments are 
instituted. The numerical method employed by 
Louis in his extensive pathological researches, 
and now adopted by his most distinguished 
contemporaries in France, affords the means of 
as near an approach to certainty on this head, 
as the subject itself admits. And I may add, 
that no previous medical inquirer has apparently 
submitted to the profession any species of 
evidence so broad in its foundations, and so 
convincing in its results, as that which charac- 
terizes the great works of this author on 
Phthisis and Typhoid fever. 

In regard to acknowledged self-limited di^ 
eases, the question wiU naturally arise, whether 
the practitioner is called on to do nothing for 
the benefit of his patient ; whether he shall fold 
his hands, and look passively on the progress of 
a disease, which he cannot interrupt To this 
I would answer, — by no means. The opportu- 
nities of doing good may be as great in these 
diseases as in any others ; for, in treating every 



SELF-LIMITED DISEASES. 35 

disease, there is a right method, and a wrong. 
In the first place, we may save the patient from 
much harm, not only by forbearing ourselves to 
afflict him with minecessary practice, but also 
by preventing the ill-judged activity of others. 
For the sanie reason that we would not suffer 
him to be shaken in his bed, when rest was 
considered necessary to him, we should not 
allow him to be tormented with useless and 
annoying applications, in a disease of settled 
destiny. It should ^ be remembered that all 
cases are susceptible of errors of commission, as 
well as of omission, and that by an excessive 
application of the means of art, we may frus- 
trate the intentions of nature, when they are 
salutary, or embitter the approach of death when 
it is inevitable. What practitioner, I would 
ask, ever rendered a greater service to mankind, 
than Ambrose Pare, and his subsequent coadju- 
tors, who introduced into modern surgery the 
art of healing by the first intention? These 
men with vast difficulty succeeded in convinc- 
ing the profession, that instead of the old meth- 
od of treating incised wounds by keeping them 



86 SELF-LIMITED DISEASES. 

open with forcible and painful applications, it 
was better simply to place the parts securely in 
their natural situation, and then to let them 
alone. In the second place, we may do much 
good by a palliative and preventive course, liy 
alleviating pain, procuring sleep, guarding the 
diet, regulating the alimentary canal, — in fine, 
by obviating such sufferings as admit of miti- 
gation, and preventing or removing the causes 
of others, which are incidental, but not neces- 
sary, to the state of disease. In doing this, we 
must distinguish between the disease itself, and 
the accidents of the disease, for the latter often 
admit of relief, when the former do not. We 
should also inquire whether the original cause 
of the disease, or any accessory cause, is still 
operating, and if so, whether it can in any 
measure be prevented or removed ; as, for ex- 
ample, when it exists in the habits of life of the 
patient, in the local atmosphere, or in the pre- 
sence of any other deleterious agent. [Note K.] 
Lastly, by a just prognosis, founded on a correct 
view of the case, we may sustain the patient 
and his friends during the inevitable course of 
the disease ; and may save them from the pangs 



SELF-LIMITED DISEASES. 37 

of disappointed hope on the one side, or of un- 
necessary despondency on the other. 

It will be seen that, in the foregoing remarks, 
a low estimate has been placed on the resources 
X}{ art, when compared with those of nature. 
But I may be excused for doing this in the 
presence of an audience of educated men, and 
the members of a society, whose motto is NatUr' 
rd duce. The longer and the more philosophi- 
cally we contemplate this subject, the more 
obvious it will appear, that the physician is but 
the minister and servant of nature ; that in cases 
like those which have been engaging our con- 
sideration, we can do little more than follow in 
the train of disease, and endeavor to aid nature 
in her salutary intentions, or to remove obstacles 
out of her path. How little, indeed, could we 
accompliah without her aid ! — It has been 
wisely observed by Sir Gilbert Blane, that *the 
benefit derivable to mankind at large, from 
artificial remedies, is so limited, that if a spon- 
taneous principle of restoration had not existed, 
the human species would long ago have been 
extinct.' * 

* Medical Logic, p. 49« 



88 SELF-LIMITED DISEASES. 

The importance and usefulness of the medi- 
cal profession, instead of being diminished, will 
always be elevated, exactly in proportion as it 
understands itself, weighs justly its own powers, 
and professes simply what it can accomplish. 
It is no derogation from the importance of our 
art, that we cannot always control the events of 
life and death, or even of health and sickness. 
The incompetency which we feel in this respect, 
is shared by almost every man upon whom the 
great responsibilities of society are devolved. 
The statesman cannot control the destinies of 
nations, nor the military commander the event 
of battles. The most eloquent pleader may fail 
to convince the judgment of his hearers, and the 
most skilful pilot may not be able to weather 
the storm. Yet it is not the less necessary, that 
responsible men should study deeply and under- 
standingly the science of their respective voca- 
tions. It is not the less important, for the sake 
of those whose safety is, and always will be, 
committed to their charge, that they should look 
with unbiased judgment upon the necessary 
results of inevitable causes. And while an 
earnest and inquiring solicitude should always 



SELF-LIMITED DISEASES. o9 

be kept alive, in regard to the improvement of 
professional knowledge, it should never be for- 
gotten, that knowledge has for its only just and 
lasting foundation, a rigid, impartial, and inflex- 
ible requisition of the truth. 



40 SELF-LIMITED DISEASES. 



NOTES. 



NOTE A. 
The difficulty of discriminating between the 
symptoms of disease, and the effects of treat- 
ment, has undoubtedly led to much erroneous 
practice, so that we cannot be too careful or 
vigilant, in watching the consequences of our 
own remedies. For a long time the effects re- 
sulting from an excessive use of mercury, were 
mistaken for the phenomena of syphilis. The 
arterial reaction, described by Marshall Hall, 
which sometimes follows excessive blood-letting, 
has been confounded with the arterial action of 
disease requiring further depletion. Constitu- 
tional irritation, produced or kept up by an 
inordinate use of vesicatories and other counter- 
stimulants, has been made a reason for the 
farther continuance of those applications. Much 
acute and unnecessary suffering has been caused 
by the prolonged application of sinapisms to the 



NOTES. 41 

tender akins of infants, and the limbs of dying 
patients. The pains of hunger, resulting from 
a too restricted diet, are most keenly felt by 
convalescents from sickness ; yet we sometimes 
see the cries of infants, arising from this cause, 
mistaken for signs of disease, and met by the 
practitioner with medicines, and farther restric- 
tions. I do not speak of these things as com- 
mon occurrences, yet they have been sufficiently 
so, to render it obvious that circumspection, on 
the part of the practitioner, is necessary to avoid 
them. 

NOTE B. 

The vaccine vesicle might, if it were desired, 
be extirpated by the knife or caustic, although if 
the vesicle be sufficiently developed to excite no- 
tice, the surgical remedy would be at least as bad 
as the disease. In regard to medical remedies, 
I have had occasion to observe their inefficiency 
in cases where inflammatory diseases, requiring 
treatment, have occurred during the progress of 
cow pox. The depletive remedies employed 
for the former diseases did not affect the pro- 
gress of the vaccine vesicle. When this vesicle 



42 



SELF-LIMITED DISEASES. 



is slow and diminutive, it is commonly owing 
to the coexistence of some other cutaneous 
affection. 

In regard to mercurial salivation, although 
the treatment proposed by Dr. Pearson and 
others, may have been reiterated in many vol- 
umes, yet I believe that most practitioners of 
experience find themselves obliged to rely upon 
time and palliatives, aided by the withdrawal of 
the cause. 

NOTE C. 

The modern introduction of the non-mercurial 
treatment in syphilis, might almost lead us to 
consider this malady also, as among the self- 
limited diseases. Although syphilis, as it exist- 
ed in the days of Mr. Hunter, appears to have 
yielded to mercury alone, so that this eminent 
author regarded it as one of the distinguishing 
traits pf the disease, that it had no tendency to 
spontaneous recovery ; yet the experience of the 
last twenty years has shown that syphilis, as it 
now exists in all its prominent varieties, has 
been cured in many thousands of cases, by a 
treatment in which no mercury in any shape is 



NOTES. 43 

employed Nevertheless, the treatment by. th *. 
anti-phlogistic method, which has been substi- 
tuted, requires, in order to be successful, more 
or less depletion, abstinence, and positive rest,* 
conjoined occasionally with other remedies. So 
that the disease still undergoes efficient treat* 
ment ; and indeed, when it is wholly neglected, 
as it sometimes is by the abject and the reck- 
less, it results in the most deplorable conse- 
quences, of which our hospitals and almshouses 
furnish sufficient and frequent examples. 



NOTE D. 
Corvisart died of a disease of the heart ; 
Laennec and Armstrong of pulmonary con- 
sumption. Other examples may be found of 
persons who were writers on the diseases of 
which they afterwards died. 



NOTE E. 
Ulceration in the tonsils and palate is the 
most common lesion in scarlatina, but the other 
morbid appearanoes discovered in autopsies of 



44 SELF-LIMITED DISEASES. 

cases of this disease are exceedingly various and 
uncertain. Among those which I have observed, 
or which have been noticed by my medical 
friends in this city, are ulcerations in the larynx, 
and inflammation of the mucous membrane of 
the trachea and bronchiee. In one case of thirty- 
six hours duration, the chief morbid appearance, 
in addition to the ulcerated throat, was an ex- 
tensive peritonitis with eflusion of coagulating 
lymph lining most of the abdominal cavity. 
Serous efiusions in and upon the brain have 
been occasionally noticed, but most frequently 
in the secondary forms of the disease. In the 
child of an eminent physician in this city, whose 
case and autopsy I witnessed, there was slight 
ulceration of the tonsils, but no lesion of any 
important viscus couJd be detected, though dili- 
gently sought for by our best pathological anat- 
omists. Two similar cases have been stated to 
me, and I find them also noticed by some wri- 
ters on the disease. In these cases the poison 
of the disease seems to destroy life, without 
exciting inflammatory action. 

Family predisposition appears to influence 
the tendency to mortality in scarlatina. In 



NOTES. 45 

some cases the children of a family all die in 
rapid succession. A predisposition to take the 
disease seems also affected by the same cause, 
so that it sometimes operates during the same 
season upon members of the same family resid- 
ing in different places, without personal inter- 
course. 

The latent period between the inception and 
development of this disease appears subject to 
great variation. I knew a patient to be taken 
with scarlet fever in forty-eight hours after 
arriving in this country by a passage of forty 
days from Europe. In this instance, as no case 
existed in the ship, the latent period must have 
been less than two days, or more than forty. 

Scarlatina and some other eruptive fevers 
reciprocally affect the d^elopment of each 
other. During the prevalence of measles and 
scarlet fever in this -city in the winter and spring 
of 1832, a considerable number of cases occur- 
red, in which the two diseases, each preserving 
its own distinctive character, were successively 
passed through by patients, without quitting 
their beds, yet the diseases were in no wise 
blended, or intermixed. In the family of a lady 



46 SELF-LIMITED DISEASES. 

residing in Tremont Place, five individuals had 
scarlet fever, and three of them measles, nearly 
at the same time. The circumstances are in- 
teresting. One child had measles first, the dis- 
appearance of which was immediately followed 
by scarlatina; both diseases proved mild, and 
were completed in about twenty days. Another 
child had severe scarlatina with a bad throat, 
the ulcers of which were not healed before the 
sixteenth day. After this the patient remained 
•stationary, with a quick pulse, and without 
return of appetite or strength for several days 
more, when the eruption of measles appeared 
under the cuticle which was desquamating from 
scarlatina, and passed through its regular course. 
A third child in the same family was affected 
in a more singular manner. The eruption of 
measles appeared first, with slight catarrhal 
symptoms, and continued one day. It then 
vanished, and was in two days succeeded by 
iscarlet fever. This lasted about a week, and 
when the patient was expected to get well, the 
"Vimson eruption of measles reappeared, and 
ited three days more. In these cases the two 
eases, though probably coexisting in the 



NOTES. 47 

body at the same time, and in the last case 
decidedly so, were never extant at once in an 
active or characteristic form. There was no 
reason to suppose that the intensity of either 
disease was diminished, or aggravated, by the 
presence of the other. 

Scarlet fever exists in some cases where its 
presence is not suspected, as the following cases, 
selected from a number of similar ones, may 
show. A child, previously well, was taken in 
fits at night, and died on the following morning. 
As the disease was not epidemic at the time, 
the nature of the complaint was not suspected 
till a few hours before death, when another 
child coming out with the eruption, this circum- 
stance led me to an examination of the throat 
of the first, which was found ulcerated. In 
another case, a child was affected with a very 
troublesoftie rheumatic stiff* neck. On inquiry, 
it was ascertained that a scarlet efflorescence 
had existed on the preceding week, of which the 
rheumatism was doubtless a sequel, though the 
nature of the eruption had not been appre- 
hended. 

The sequels or secondary effect^ of scarlet 



48 SELF-LIMITED DISEASES. 

fever are extremely various. Rheumatic affec- 
tions are among the most common. Dropsical 
effusions are frequent, both in the cellular tex- 
ture and in large cavities. Anasarca and ascites 
are not of uncommon occurrence. I have seen 
hydrocele, which disappeared spontaneously in 
a few weeks, and hydrocephalus which proved 
fatal. Troublesome indurations of the parotid 
and submaxillary glands often occur, and may, 
or may not, be followed by suppuration. A 
fatal induration of the whole anterior neck is 
sometimes met with. This I have seen both in 
the primary and secondary disease. A purulent 
or sanious discharge from the ears occasionally 
follows scarlet fever, and sometimes continues 
long enough to destroy the organic texture, and 
with it the sense of hearing, in one or both ears. 
Erysipelas and roseola are among the other 
pearances which I have seen to supervene upon 
this uncertain disease. Fortunately, however, 
the largest portion of cases are attended with no 
sequelae, or with such as disappear spontane- 
ously in their own time, without permanent 
injury to the patient 



NOTES. 49 

NOTE P. 

We have sufficient evidence that many cases 
of gout, both in this country and Europe, have 
had their paroxysms abridged by the use of 
colchicum, and different species of veratrum. 
Some individuals are fortunate enough to obtain 
this effect under a moderate dose, which only 
affects the bowels. But in most persons it is 
necessary to take enough of the medicine to 
produce vomiting and temporary prostration, 
before the desired result can be obtained. This 
effect is sometimes so severe that many patients 
prefer the disease to the remedy, and in fact the 
practice is hardly warranted in the case of very 
feeble or aged persons. 

Three cases have occurred to me, in which 
gout has disappeared altogether under an entire 
abstinence from spirituous and fermented liquids. 
In one of these it is now thirteen years since p. 
paroxysm occurred, and in another seven years, 
the individuals both enjoying good health, and 
leading active lives. The third case was that 
of a gentleman of this city, lately deceased at 
seventy-six years of age, who had suffered more 
4 



50 SELF-LIMITED DISEASES. 

than twenty years with gout, and was reduced 
to use crutches. After commencing a course of 
entire abstinence, the paroxysms began to abate 
in violence, and for the last seven years of his 
life he assured me he had not felt the sensation 
of gout In his last illness a slight chiragra 
occurred after taking a dose of tincture of rhu- 
barb* Some other cases are now in the progress 
of trial, with apparent alleviation of the disease* 
I have been told by others, that this plan of 
treatment has in some instances failed to be 
followed by relief, and very probably this may 
be true ; but such instances have not yet come 
under my personal observation, where the ex- 
periment has been fairly made in the acute dis- 
ease. 

NOTE G. 

The natural history of the small ascarides is 
curious, and not well understood. Many indi- 
viduals are infested with them in childhood, but 
get rid of them as they advance in years. Some, 
however, are troubled with them during the 
whole of a long life, though they are represented 
as less annoying after middle age, than before. 



NOTES. 51 

Tbey most commonly appear periodically, both 
in children and adults, after intervals of from 
three to six weeks. During the intervals they 
are neither felt nor seen in the discharges^ 
Their periodical return is announced by a sense 
of itching and burning at the extremity of the 
Tectum, felt principally in the evening, some- 
times producing tumefaction, and eruption of 
the neighboring skin. This irritation continues 
to recur every evening for perhaps a week, or 
more, and then ceases. During this time the 
worms are discharged alive and active in every 
alvine evacuation. Cathartics and enemata 
bring away vast numbers of them, but without 
diminishing the annoyance occasioned by those 
which remain behind. At length they sponta- 
neously cease, to appear, the irritation subsides, 
cathartics no longer bring them to light, and the 
inexperienced practitioner flatters himself that 
the evil is remedied. Nevertheless, after a few 
weeks, they again return in undiminished num- 
bers, attended by the same phenomena as before. 
Whether the new race are cotemporaries of the 
old, or descendants from them, it is not easy to 



52 SELF-LIMITED DISEASES. 

tell ; but the latter supposition seems most 
probable. 

It is commonly believed that the principal 
residence of ascarides is in the rectum, because 
they are most felt there. They have been 
found, however, in other parts of the alimentary 
tube. Many patients, immediately after a ces- 
sation of the annoyance in the rectum, are 
visited by pain in the epigastrium, attended 
with costiveness and clay-colored discharges. 
This state continues for two or three days, and 
is then followed by a bilious diarrhoea. I have 
repeatedly known these consecutive events to 
occur with great regularity for half a dozen 
years, so much so that my inquiries are gene- 
rally directed towards this cause, when children 
have complained of epigastric pains at regular 
periods. Whether, in these cases, the worms 
ascend to the duodenum and mouth of the 
biliary duct, or whether the whole is an affair of 
sympathy, future autopsies may perhaps de- 
termine. 

The nidus of these animals, and perhaps the 
food also, appears to be the mucus which lines 



NOTES. 53 

the alimentary canal. Buried in this substance, 
they resist the effect of the most violent cathar- 
tics and vermifuges, oil of turpentine and croton 
not excepted. If it be permitted to derive an 
hypothesis from the phenomena which they 
exhibit, it would be, that during a greater part 
of the time, they remain quietly embedded in 
this mucus, deriving from it their habitation and 
nourishment, being at the, same time secured 
from the effects of the peristaltic motion by 
this and by the ahhesive power of suction ; but 
that at certain periods, perhaps at their genera- 
ting seasons, they issue forth from this covert, 
and mingle themselves in the contents of the 
alimentary canal ; in consequence of which they 
are liable to be expelled with the common mass. 
I have known ascarides to be eradicated by sC 
severe dysentery. In some cases they have been 
totally removed by large injections of oil, par- 
ticularly of lamp oil. But more frequently they 
resist these and most other remedies for a series 
of years. A temporary palliative may always 
be found in small injections of weak salt water, 
or even of an ounce or two of cold water. 



54 8BLF-LIMITED DISEASES. 

NOTE H. 
I would by no means undervalue the exer- 
tions which have been made, and are still mak- 
ing by indefatigable and distinguished men, for 
the control of what are called pestilential epi-^ 
demies. I would only be understood to state 
that no one method of treatment, in the diseases 
enumerated, appears to have acquired sujficient 
credit with the profession generally, to be turned 
in their hands to any great practical account. 
The records of medical literature show, that a 
period of ten years has seldom elapsed, without 
the annunciation of some effectual mode of 
practice, in some one of these diseases. And 
what is more, the amount of evidence with 
which these statements are supported, and the 
pathological skill with which the indications are 
explained, seem sometimes sufficient to shake 
the incredulity pf the most scepticcd. Neverthe- 
less, after a certain term of years the diseases . 
are found to be fatal as before, and fresh inno-^ 
vations in practice take the place of the old^ 
and excite confidence anew among the sanguine, 
and ardent members of the profession. The 



NOTES. 59 

tmth 18, that no epidemic is equally malignant 
in all seasons and places; and from some un« 
known cause, the laws which aiffect its tendency 
to death or recovery, are essentially diffierent in 
different climates at the same period, or in the 
same climate at diflferent periods, • This fact 
must be known to those who have personal 
experience in regard to these diseases, or who 
ajre conversant in their epidemic history. Reli- 
ance, therefore, cannot be justly ietccorded to any 
mode of treatment which has not had the testi- 
mony of a large number of years in its favor, 
and this also under a proper variety of situations 
and circumstances. Were it otherwise, these 
diseases, in the hands of the medical profession, 
would long ago have ceased to be pestilences. 



NOTE L 
I am aware that some of the most distin- 
guished French pathologists of the present day 
incline to the opinion that many acute diseases, 
or at least inflammations, are incapable of being 
shortened in their duration, by art. [See mar- 
ginal note^ p&ge 19-] The opposite opinion 



56 SELF-LIMITED DISEASES. 

prevails very generally in this country and in 
England, and it would be premature to consider 
the question as decided, until it has been sub- 
mitted more extensively to the test of comparia- 
tive numerical results. It is certain, that the 
most distressing symptoms of acute inflamma- 
tions are often arrested at once by remedies. 
This happens, for example, from blood-letting 
in croup and pleurisy, and from opium in stran- 
gury and dysentery. If, however, the disease is 
fully established before the application of reme- 
dies, it usually goes on to complete its course, 
and in that case the remedies are palliatives 
only. And if remedies be applied in the in- 
cipient stage, an uncertainty hangs over our 
diagnosis, for the supposed pleurisy may have 
been rheumatism, and the supposed croup may 
have been catarrh, or laryngismus ; for even the 
physical signs require a certain maturity of 
development in disease, to render them satisfac- 
tory. Leaving then, as undecided, the question 
of positive duration in acute inflammations, we 
do not risk much in asserting that their charac- 
ter is often essentially modified by treatment, 
so that they are more easily supported by the 



NOTES. 57 

patient, and the apparent danger attending 
them, diminished. We must wait for the 
modern spirit of accurate inquiry to furnish a 
further light on this subject. 



NOTE K. 
As examples, it may be stated that the sali- 
vation produced by mercury gets well of itself, 
provided the original cause is discontinued. 
An issue made by caustic, or otherwise, gets 
well after the original cause has ceased to 
operate ; but if an accessory cause is present, 
such as the pressure of an irritating foreign 
substance, it then fails to heal. The local 
atmosphere may be considered as an original, 
or an accessory cause, in those diseases which 
are benefited by change of climate or situation. 
A long train of diseases might be mentioned, 
which are brought on, or kept up, by injurious 
habits of life, and are relieved or cured, not by 
medicines, but by a removal of the habit under 
which they have been, or continue to be, induced. 
Such are the diseases which attend on sedentary 
life, intemperate indulgences, lactation, insalu- 



58 BELF-LIMITED DISEASES. 

brity of diet, &c« Sometimeft a disease, the 
cause of which is not removed, may disappear 
in consequence of a new habit, by which the 
system becomes capable of bearing with impu** 
nity the influence of this cause; as in sea- 
sickness. 



ON THE 
f 

TREATMENT 0E DISEASE: 

AX INTBODUOTOBT LBOTDSI, DHUTBBED BIVOBB THE MEDICAI 
CLASS IX THE MASSAOHUBETIS ICEDIPAL OOLLEGE IS BOSTO^i 
KOYSKBEB 3, 1852. 

Of the sciences which have most occupied 
the time and labor of mankind, a certain num- 
ber lead by their investigations to clear and 
positive results, and enlarge the amount of 
human knowledge by the discovery and pro«» 
mulgation of absolute truth. Another portion 
lead only to results which are probable or pre- 
sumptive in their character, and which furnish 
to mankind rules of action, in cases where better . 
lights cannot be obtained. To the former class 
has been given the name of exact sciences, and 
to the latter the name of presumptive or conjec- 
tural sciences. Mathematics form an exact 
science, on the conclusions of which, when once 



60 



TREATMENT OF DISEASE. 



known, there can be no difference of opinion. 
In like manner, chemistry and mechanics, as- 
tronomy and portions of natural history, are 
examples of exact sciences, the demonstrations 
of which, when once made clear, may after- 
wards be modified and enlarged, but are never 
fundamentally shaken. On the other hand, the 
important sciences of ethics and politics, of 
commerce and finance, of government, and 
speculative theology, are inexact in many of 
their principles, as is proved by the widely 
different constructions under which men re- 
ceive and apply them to practice. 

It would at first seem that the exact sciences 
were those most worthy the cultivation of intel- 
ligent minds, inasmuch as they lead to satisfac- 
tory, and therefore to gratifying results; and 
because, in their more elevated departments, 
they involve and require some of the highest 
reaches of the human intellect. But in the 
opinions of mankind, as evinced by their prac- 
tice, the opposite judgment prevails, and proba- 
bly nine-tenths of the labor of educated and 
intellectual men are employed on studies which 
are, in their nature, uncertain and conjectural. 



TREATMENT OF DISEASE. 61 

The cause of this great ascendancy in the 
attention given to the inexact sciences, is to be 
found in the vast and paramount importance of 
their subjects, and also in the difficulty of con- 
summating their great ends. It is much more 
important to mankind to know how to avoid 
anarchy and crime, war, famine, poverty and 
pestilence, than it is to know that the planet 
Saturn has a ring, or that a lily has six stamens, 
that light can be polarized, or that potass can 
be decomposed. Yet while the latter proposi- 
tions are susceptible of absolute demonstration, 
the former processes, which bear directly on 
human happiness or misery, are frequently re- 
moved beyond our foresight or control. The 
wisest men often fail to influence the destinies 
of states, families, and individuals, and the 
shrewdest calculators are baffled in regard to a 
coming crop, a pecuniary crisis, a glut in the 
commercial market, or a change in the public 
morals. Nevertheless, the wise man, conscious 
of superior talent, and the philanthropist desi- 
rous of the public weal, and even the interested 
man who looks to his personal advantage and 
progress, must give themselves and their ener 



62 TREATMENT OF DISEASE. 

gies to studies which involve the immediate 
wants of their fellow-men, even though their 
best directed efforts should fail of the denied 
resul^. And the simple reason is, that if the 
best qualified minds decline to undertake this 
task, it will most assuredly be assumed by the 
ignorant and presumptuous. 

Preeminent among the inexact and specula*- 
tive sciences stands practical medicine j a science 
older than civilization, cultivated and honored 
in all ages, powerful for good or for evil, pro* 
grcssive in its character, but still unsettled in its 
principles; remunerative in fame and fortune 
to its successful cultivators, and rich in the fruits 
of a good conscience to its honest votaries. En* 
cumbered as it is with difficulty, fallacy and 
doubt, medicine yet constitutes one of the most 
attractive of the learned professions. It is 
largely represented in every city, village, and 
hamlet Its imperfections are lost sight of in 
the overwhelming importance of its objects. 
The living look to it for succor— the dying call 
on it for rescue. 

The greatest boons and the most important 
objects presented to our aspirations in this life^ 



TREATM^BNt OF PlS^IASS. 63 

are not to be approached through paths which 
are straight and unmistakable. The avenues 
to most of them aire shadowed by doubts ot 
clogged with incessant obstacles. Next to the 
Spiritual welfare of men, the preservation of 
their lives, the peace and safety of their com- 
munities, the acquirement and preservation of 
their worldly goods are among the objects 
which take strongest hold on their desires. 
Yet grave doubts are justifiable, whether any 
precise means have yet been agreed upon by 
which these desirable ends can with certainty 
be attained. And if any one deems it a re- 
proach on medicine that its cultivators have 
not arrived at a common faith and practice, let 
him consider whether the laborers in other fields, 
however honest their, intentions, are agreed in 
their theological creeds and political platforms. 
Considering the great importance of the ob- 
jects of medicine, the frequent and earnest 
appeals made for its assistance, and the vast 
sums annually expended in its remuneration, it 
is not surprising that disappointment and com^ 
plaint often follow the failures, necessary or 
tmnecessary, of medical practice. <Man is of 



64 TREATMENT OF DISEASE. 

few days and full of trouble.' Yet in the face 
of this acknowledged truth, he requests and 
expects that his ghysician will provide him with 
many days, and remove at least his bodily 
troubles. This expectation on his part is rea^ 
sonable or otherwise, according to the circum- 
stances under which it is made. It is unrea- 
sonable if his case is helpless, and he is merely 
paying the debt of suffering and death which 
his mortal nature exacts. But it is reasonable 
and proper, if his complaint is of a curable kind, 
or if, whether curable or not, his physician has 
claimed and vaunted the power to remove it. 

Most men form an exaggerated estimate of 
the powers of medicine, founded on the common 
acceptation of the name, that medicine is the 
art of curing diseases. That this is a false defi- 
nition, is evident from the fact that many dis- 
eases are incurable, and that one such disease 
must at last happen to every living man. A 
far more just definition would be, that medicine 
is the art of understanding diseases, and of 
curing or relieving them when possible. Under 
this acceptation our science would, at least, be 
exonerated from reproach, and would stand on 



TREATMENT OF DISEASE. 65 

a basis capable of supporting a reasonable and 
durable system for the amelioration of human 
maladies. 

Every young man who proposes to become a 
member of the medical profession, should ask 
himself whether he considers medicine a liberal 
and honorable science, to be followed for the 
good it may do to mankind, or as a dishonest 
trade, to be pursued for the purpose of profiting 
himself by the deception of his fellow-men. If 
he accepts his profession in the first sense, he 
will strive to understand his science in all its 
bearings, and practise it with conscience and 
fidelity; if in the latter, he will put his con- 
science aside, and study only the low arts which 
entrap the credulous and unwary. 

With the trade of medicine I have nothing to 
do. Knowing that I address an ingenuous and 
cultivated audience, composed mainly of young 
men who are looking forward to an honest and 
honorable place in professional life, I make no 
apology for proceeding to express my belief of 
the manner in which medicine should be prac- 
tised and disease treated, for the reciprocal 
5 



66 TREATMENT OF DISEASE. 

benefit of him who gives, and of him who 
receives its aids. 

Let no one deceive himself by believing that 
success, stable, permanent, honorable success, 
can be attained v^ithout knowledge of the great 
principles of the profession and science of med- 
icine. This knowledge must consist in an 
accurate acquaintance with the structure and 
offices of the human body, and the laws of its 
healthy condition. After these follows the sci- 
ence of pathology, involving the great and 
fundamental art of diagnosis, by which the dis- 
eases of the human body are detected, and 
distinguished rightly from each other. The 
power of distinguishing diseases lies at the root 
of all correct and enlightened practice, and 
without it all medical action is empirical and 
fortuitous. There is no more pernicious error 
than for a physician to believe that he can pre- 
scribe safely for the symptoms of a sick man, 
without understanding, in some measure, the 
nature of his disease. Symptoms are of various 
import, according to the *seat of their origin and 
the nature of their causes ; and if taken alone 
without a correct interpretation of these attend- 



TREATMENT OP DISEASE. 67 

ant considerations, they often lead to a wrong 
result, or to no result at all. A patient not 
unfrequently sends for a physician on account 
of a certain symptom which is distressing him, 
and which may be, for example, a pain in the 
abdomen, or in the head. Now a pain in the 
abdomen may arise from colic or peritonitis, 
from rheumatism or neuralgia, from dysentery, 
from calculus, carcinoma or strangulation. And 
in like manner, a pain in the head may arise 
from a multitude of different and even opposite 
causes. Now it is well known that the kind of 
treatment which is effectual in one case, is per- 
nicious in another ; and he who prescribes for 
the symptom irrespectively of the cause, is quite 
as likely to do mischief to his patient as good, 
and quite as likely to destroy life as to save it. 

If the question be asked, what makes a great 
physician, and one who is appealed to by his 
peers, and by the discerning portion of the pub- 
lic, for counsel in difficult cases, I would answer, 
that he is a great physician who, above other 
men, understands diagnosis. It is not he who 
promises to cure all maladies, who has a reme- 
dy ready for every symptom, or one remedy for 



'68 TREATMENT OF DI8EA8B. 

all symptoms; who boasts that success never 
fails him, when his daily history gives the lie to 
sQch assertion. It is rather he, who, with jnst 
discrimination, looks at a case in all its difficul- 
ties ; who to habits of correct reasoning, adds 
the acquirements obtained from study and ob- 
servation ; who is trustworthy in common things 
for his common sense, and in professional things 
for his judgment, learning, and experience ; who 
forms his opinion positive or approximative, 
according to the evidence ; who looks at the 
necessary results of inevitable causes; who 
promptly does what man may do of good, and 
carefully avoids what he may do of eviL Ex- 
amples are rare of this perfection, yet for an 
approach to such a standard of professional 
•excellence, I would venture to direct your re- 
membrance to the venerable ex-professor, fortu- 
nately yet among us, of the theory and practice 
in this University. 

Every citizen whose capacity is able to reach 
the ordinary affairs of life, is aware that the 
persons most capable of discharging the com- 
mon offices, or of exercising the common arts 
and duties of life, are the individuals who have, 



TREATMENT OF DISEASE. 69 

by talents, education and practice, become ex- 
perts in those arts and duties ; — and that, on 
the other hand, those persons who profess to 
have acquired knowledge by intuition, to have 
become learned without labor, and to have 
arrived by short cuts at results and qualifications 
which demand years of preparatory training, 
must be incompetent and treacherous sources of 
reliance. And it is the general admission of 
this truth which gives support and confidence 
to the various professions, arts and callings, to 
which men devote their lives. 

A little machine called a watch is carried 
about by most persons, and when this machine 
has stopped or is out of order, they do not lay 
their own ignorant hands upon it, but submit 
the case to the skill of an expert, who is known 
to be qualified to judge and act in such cases. 
It is the duty of this artist when applied to, to 
examine the interior of the watch, to ascertain 
by the use of his skill, in what part the disease 
is situated, and to apply to that part the appro- 
priate remedy. If a spring or a chain is broken, 
it must be restored; if the wheels are out of 
gear, they must be put in place ; if the hands 



70 TREATMENT OF DISEASE. 

only have caught, they have only to be liberated, 
and if the pivots are dry and rough, they must 
bo oiled or cleaned; — and lastly, if the watch 
has had a destructive fall, if it has been crushed 
by being trodden on, if it has lain a month in 
the salt water, or if it is worn out by running 
steadily for threescore years and ten, then the 
case is incurable, and the only palliative advice 
which the practitioner can render is, that the 
owner should procure a new watch, or reconcile 
himself to do without one. 

But suppose there resides in the place a 
watch doctor who prescribes for symptoms, and 
who, among other things, has a remedy for the 
symptom of stopping, and that this remedy con- 
sists in a certain kind of friction, shaking, or 
manipulation, an ointment applied to the out- 
side, or an invisible particle of some nugatory 
substance inserted into the inside ; and suppose 
that one or two watches in a hundred which 
had stopped by accident, should by accident 
resume their motions under such treatment, 
could anything but the most unmitigated folly 
' the inference that such a person is entitled 
ome the accredited horologer to the com- 



TREATMENT OF DISEASE. 71 

What is so conspicuously true in the common 
business of life, is only an example of what is 
more vitally true in the practice of medicine. 
K a man has had the misfortune to get a shot 
or a stab in his body, he does not need a doctor 
who administers a specific dose or a sovereign 
plaster for holes in the body ; he wants a man 
who can tell him whether the wound has passed 
inside or outside of his peritoneum, and whether 
it is requisite for him to make his will, or to 
make arrangements for pursuing his journey. 

But the prescribing for symptoms in the dark 
is not the only instance in which false logic has 
entered into medical reasoning. It is not less 
absurd to suppose that disconnected events, 
which have closely followed each other, have 
therefore a necessary dependence upon each 
other. Shrewd, practical men do not thus gov- 
ern themselves in the common affairs of life. 
A merchant about to send a ship to sea, en- 
deavors to find a captain to take charge of her 
who understands navigation, who can keep his 
run and determine his place, who studies the 
weather and is on the lookout for a lee shore, 
and who in emergencies can judge whether it is 



72 TREATMENT OF DISEASE. 

necessary or not to cut away the masts or throw 
over the cargo. But suppose a man appears, 
and such have been, who announces that he has 
a specific bottle of oil with which he cures 
tempests, and by pouring a teaspoonful of which 
upon the waves, the storm is speedily made to 
cease ! Would any prudent owner intrust his 
vessel to such a man and on such grounds, even 
though he should produce a hundred certificates 
that storms had stopped in half a day, or half 
an hour after the application of his remedy ? 
For these certificates, if true, would only prove 
that in a certain number of cases, a result had 
followed by accident, which common sense, and 
if necessary, a thousand opposite cases would 
show had nothing to do with the pretended 
cause. 

What would be true of the apparent or al- 
leged cure of a tempest at sea, is no less true of 
the pseudo-cures which every day take place in 
diseases which are self-limited, paroxysmal or 
recidivous in their character. There are doubt- 
less living many men who believe themselves to 
have been cured half a dozen times of various 
diseases, of fevers and inflammations, of neu- 



TREATMENT OF DISEASE. . 73 

ralgia, rhenmatism, gout and asthma ; and each 
time perhaps by a different remedy, but who on 
the next imprudence or returning period, are 
destined to find themselves feverish, neuralgic, 
gouty, or asthmatic still. 

Deceptions in medicine are occasioned not 
only by the dishonesty of charlatans, but quite 
as often by the well-meaning credulity of other 
practitioners, whose intellect is impulsive, or 
whose education has been unduly curtailed. 
It is so flattering to a man's self-love to believe 
that his chance shots have sometimes taken 
effect, that physicians of regular position may 
pass their lives in mere speculative and random 
efforts at curing diseases, shutting their eyes 
against their own failures, and not allowing 
themselves to consider that in a certain portion 
of successful cases which they had failed to 
understand, the disease in truth got well with- 
out, or perhaps in spite of, their misdirected and 
embarrassing practice. 

Medicine is a great good and an unquestion- 
able blessing to mankind, when it is adminis- 
tered by discriminating and intelligent hands 
with sincerity and good judgment. It disap- 



74 ^ TREATMENT OP DISEASE. 

points expectation, and fails to accomplish its 
mission, when the agent who dispenses it falls 
into the mistaken resource of professing infalli- 
bility, and of raising hopes which he knows not 
how to accomplish. No man is deemed to be 
safe in his worldly affairs who is afraid to look 
into his own pecuniary condition. Neither is a 
physician safe in his practice or his reputation, 
who is afraid to face the case of his patient in 
all its bearings. That man is most to be relied 
on who looks calmly and understandingly at 
the emergency before him, who knows the im- 
port of signs, and deduces from them the proba^ 
ble tenor of coming events; who is aware of 
the great truth that all men must die, but is 
also aware of the more gratifying truth that 
most sick men recover ; and who, in particular 
exigencies, inquires of his reason and his knowl- 
edge, in which of these two immediate catego- 
ries his patient is placed, and how far the event 
of the case is within his control. He will then 
interfere or he will wait, he will act or he will 
forbear, as he only knows how who can form a 
correct verdict from the evidence before him, 



TREATMENT OP DISEASE. 75 

and who knows the immeasurable good or 
harm which hangs on medical practice. 

The vulgar standard of medical character de- 
pends very much on the supposed successful 
result of cases. But this is not the true stand- 
ard, for the best physicians as well as the most 
popular practitioners, often lose their patients, 
and even their own lives, from common diseases; 
while, on the other hand, the most injudicious 
treatment, and the most reckless exposures are 
not unfrequently survived. Laennec and Bichat, 
two of the most distinguished lights of modern 
medicine, died of the very diseases they were 
themselves investigating, Preissnitz, the prince 
of modern empirics, himself a robust peasant, 
died of premature disease at the age of fifty- 
two, in the midst of his own water-cure. It is 
well known, that the most thronged and popu- 
lar places of resort for grave, difficult, and 
intractable cases, are those from which there 
are most funerals. On the other hand, men 
support life in certain cases under every extreme 
of opposite treatment, under ultra-depletion and 
ultra-stimulation, under heroic practice and 
nugatory practice, under 'hot drops' and cold 



TREATMENT OF DISEASE. 



douches, under drachm doses of calomel, and 
imponderable doses of moonshine. Clot Bey, 
and his two or three associate Frenchmen, 
entered a plague hospital at Cairo in the height 
of the epidemic. They shut themselves up in 
the concentrated atmosphere of the infection, 
they remained in bed in contact with dying 
patients, they wore the shirts of those who had 
just expired, they inoculated themselves with 
the secretions of pestilential buboes,— and all 
to no purpose. They were alive some years 
afterwards, and quarrelling with each other for 
the glory of their hair-brained enterprise. Four 
thieves in the plague at Marseilles freely prose- 
cuted their robberies in the infected houses of 
the dead and dying; and the aromatic vinegar, 
which has immortalized their prophylactic prac- 
tice, was very probably an impromptu invention 
brought forward by them to procure their ex* 
emption from punishment. |9 

The humility which we may learn from the " 
limited influence of onr art on the health and 
lives of mankind, is probably a far safer guide 
to a correct practice, than the fanatical confi- 
dence with which unenlightened ultraists of 



TREATMENT OF DISEASE. 77 

every sect carry out their respective dogmas. 
In a sphere of action where some good may 
always be done, and where much harm often is 
done, and 'fools rush in where angels fear to 
tread,' it is well to consider some of the rules 
which may lead an honest inquirer after truth 
to the nearest attainment to a correct judgment 
and practice. 

Supposing, what I would fain wish might 
always happen, that the physician is duly and 
thoroughly imbued with knowledge of his sci- 
ence, the first great question which presents 
itself in every case or emergency, is that which 
involves the diagnosis. This being established, 
the practitioner is enabled to avail himself of 
the lights of reason and experience in regard to 
a correct course of therapeutic proceeding. But 
it often happens that the nature of the case 
cannot be made out in one, or two, or three 
interviews with the patient, and we are obliged 
to wait for the gradual development of diagnos- 
tic symptoms, as a judge and jury in a like case 
would be expected to postpone, or wait for the 
arrival of witnesses. It is a mistaken pride 
which leads physicians to commit themselves 



4> TRBATSfENT OP DISEASE. 

bv an oracular guess at first sight, which the 
ewnts of the succeeding day may show to have 
been erroneous. Moreover, if from the obscure 
character of the case, or the imperfection of our 
science, diagnosis is impossible, we should then 
so generalize our treatment that we may include 
what is possible of good, and exclude what is 
probable of harm. 

Having settled, as well as our means admit, 
the pathological condition of our patient, the 
next question is that which regards the probable 
tendency of the disease if left to itself. Atten- 
tion to this point is of high importance, since it 
will prevent us from neglecting our patients in 
grave and dangerous affections, as well as from 
annoying them with useless appliances in short, 
safe or unimportant cases. Many diseases are 
insidious in their origin. The nervous imbe- 
cility which has its foundation laid in modern 
schools, the slight cough and evening flush 
which herald approaching phthisis, soon get 
beyond the reach of medical means, unless sea- 
sonably detected by the wary eye of the prac- 
titioner. A simple discharge from the ear may 
terminate in deafness, and an ulcer of the cornea 



TREATMENT OF DISEASE. 79 

in loss of sight A protracted intermittent at 
length undermines the health, and neglected 
syphilis ends in a miserable death. Cases like 
these require prompt and energetic interference 
on the part of the practitioner. On the other 
hand, diseases which are light in themselves, 
and tend to speedy recovery, as common catarrh, 
hooping cough, varicella, and a host of other 
things, if they occur in healthy subjects, and 
are not complicated with graver affctions, may 
safely be left to themselves, or treated with the 
mildest remedies and cautionary measures. 

Another most important question, exercising 
the hopes and fears of every practitioner, from 
its connection with reputation, safety and life, 
is that which relates to the curability of dis- 
eases. Is the disease amenable to medical 
treatment, or not ? If the case is of a recovera- 
ble character, and happily a great majority of 
our cases are so, the physician should anxiously 
and carefully have recourse to the recorded 
authorities of his science, and to shis own per- 
sonal experience. In doing this he should be- 
ware of implicitly trusting those who have 
published only the favorable side of their prac- 



80 TREATMENT OF DISEASE. 

tice, preferring to build up a temporary reputa- 
tion rather than to promulgate unpopular truths. 
And in analyzing his own experience, he should 
equally beware of hasty generalizations, of im- 
pressions made by remarkable examples, rather 
than by aggregates of well observed and duly 
arranged cases, from which alone impartial and 
correct inferences are to be drawn. 

In accordance with such views, we shall find 
many cases which are, for the most part, capa- 
ble of being arrested or broken up by the inter- 
position of remedies. Thus the grave and 
various symptoms which result from an over- 
loaded stomach, are at once removed by the 
action of an emetic, or sometimes of a laxative ; 
colic in like manner yields to opium or to pur- 
gatives; syphilis is cured by mercury, and 
sometimes without it ; and certain inflammatory 
attacks apparently yield to seasonable depletion. 
Moreover, in other cases which cannot be thus 
arrested, but which, from their nature, must run 
a destined course, it is generally admitted that 
the safety of the patient may be promoted, or 
perhaps the duration of the case abridged by 
remedial treatment. This is believed to be true 



TREATMENT OF DISEASE. 81 

in regard to evacuations at the commencement 
of febrile and inflammatory diseases, and to a 
multitude of other remedies applicable in vari- 
ous cases. But on this subject it is extremely 
difficult to obtain decisive and satisfactory 
knowledge. It involves a question, the settle- 
ment of which is to be approached by extensive 
and contrasted numerical observations, a large 
portion of which yet remain to be made, 
although we have valuable contributions and 
examples on many subjects. 

On the other hand, when we know that a 
case is self-limited or incurable, we are to con- 
sider how far it is in our power to palliate or 
diminish sufferings which we are not competent 
to remove. Here is a most important field for 
medical practice, and one which calls for an 
exceedingly large portion of the time and efforts 
of every physician. When we consider that 
most diseases occupy, from necessity, a period 
of some days or weeks, that many of them con- 
tinue for months, and some for years, and finally 
that a large portion of mankind die of some 
lingering or chronic disease, we shall see that 
the study of palliatives is not only called for, 
6 



82 TREATMENT OF DISEASE. 

bat really constitutes One of the most common, 
as well as the most useful and beneficent em- 
ployments of a medical man. 

In the use of efficient remedies, much depends 
upon deciding the proper stage or time, to 
which their employment is applicable. Some 
curative agents can .with propriety be used only 
at the outset of the diseases, and if this oppor- 
tunity is lost, the remedies are afterwards less 
effectual, and perhaps even injurious. Vene- 
section in the early stage of certain acute dis- 
eases, may be productive of great good ; in the 
middle stages it is of less benefit, or of none at 
all ; and in the latter stages it is injurious and 
inadmissible. On the other hand, wine and 
opiates, which are strongly contra-indicated in 
the first stage, aire afterwards not only tolerated 
with impunity, but in certain cases are taken 
with decided benefit. 

But, gentlemen, the agents which we oppose 
to the progress of disease, may, by excessive or 
ill-timed application, become themselves the 
pregnant sources of disease. Every prudent 
practitioner is bound to consider the effect and 
tendency of the remedy he is using, and to in- 



TREATMENT OF DISEASE. 83 

quire whether the means employed to counter- 
act the existing disease, are not, in their turn, 
likely to produce evil to the patient ; and if so, 
whether the evil will be greater or less than the 
disease for which they are administered. The 
sudden healing of an old ulcer, issue or eruption, 
may be followed by symptoms more serious 
in their character than those which have been 
removed. Many remedial processes, if employ- 
ed in excess, or with injudicious frequency, 
result in permanent injury to the patient The 
habitual use of active cathartics, although 
attended with temporary relief, seldom fails to 
bring on or aggravate a permanent state of 
costiveness. Large and often repeated blood- 
letiing, tends to the establishment of debility 
and anemia in some subjects, or of reaction and 
plethora in others* Opium and other narcotics 
are in themselves, if abused, fertile sources of 
disease. The modern crying evil of polyphar- 
macy and over-medication, is profitable to the 
druggist, habitual to too many physicians, and 
annoying, if not detrimental, to most patients. 

On account of these and similar considera- 
tions, much discretion is needed on the part of 



84 rmsjkTMEXT of disbasb. 

the physician to enable him to judge rightly of 
the kind of treatment which it may be safe and 
proper to employ, and of the d^jee and amount 
of that treatment, and of the requisite length of 
time for its continuance. Medical practice, in 
many cases, points to the direct substitution of 
a positive good for a positive evil ; but unforta- 
nately, in other cases, it admits only of a choice 
between evils ; — and in these cases not only the 
knowledge and experience, but also the judg- 
ment and common sense of the practitioner, are 
put in indispensable requisition to lead him to 
a correct issue. 

It is wrong to suppose, as is often done, that 
the opportunities for doing good in medicine, 
are limited to the effect of specific remedies, or 
to the application of drugs and instruments. 
The enlightened physician surveys the whole 
ground of his patient's case, and looks for the 
presence of any deleterious agencies or unre- 
moved causes of disease. Many morbid affec- 
tions, which have resisted powerful remedies, 
cease speedily on the discovery and removal of 
their sustaining cause. This is the case with 
various specific complaints produced by particu- 



TREATMENT OF DISEASE. 85 

lar drugs and stimulants when habitually used. 
A child is often sick from an error in the diet, 
health or habits of the nurse or mother. An 
individual frequently suffers from the quality 
and quantity of his habitual food or drink, or of 
his exercise, air, occupation, or clothing. The 
starved infant and the overfed gourmand, the 
drunkard and the ascetic, the pale student and 
the emaciated seamstress, require removal and 
reform, not drugs and medicines. A patient 
dies of phthisis in a confined office or a damp 
northern climate, who might have enjoyed long 
life in an active occupation or a more pure and 
temperate atmosphere. On the other hand, 
men fall victims to the fevers and abdominal 
diseases of the south and west, who might have 
escaped disease by a timely removal to the north. 
It is as necessary in many cases that the physi- 
cian should inquire into the situation, diet, 
habits and occupation of the patient, as that he 
should feel his pulse or explore his chest. It 
often happens that the disordered state of the 
one cannot be corrected until the other has been 
previously set right ; and a little dietetic instruc- 



86 TREATMENT OF DISEASE. 

tion, or even moral advice, is more serviceable 
than a technical prescription* 

In regard to their duration, their probable 
issue, and their susceptibility of relief, the phy- 
sician may profitably divide his cases into three 
classes; those which are curable, those which 
are temporarily self-limited, and those which 
are incurable.* In the first class, or that of 
curable diseases, are to be included those mor- 
bid affections which we know, or have reason to 
believe, are under the control of remedies, so 
that they can be arrested, or abridged, in dura- 
tion. For the most part, acute inflammatory 
diseases, when not of fatal intensity, are mitiga- 
ted by depletion and the antiphlogistic regimen, 
more or less actively enforced, according to the 
degree of violence. Spasmodic diseases, on the 
contrary, are influenced by opiates, antispas- 
modics and tonics, and by the removal of their 
cause, when it can be discovered and remedied, 
as in the case of dentition, indigestible food, &c. 
Sympathetic diseases are to be addressed 
through the medium, organ, or texture which is 
primarily affected. Thus, a headache depend- 

* See note, page 9. 



TREATMENT OF DISEASE. 87 

ing upon a disordered stomach, or a hysteric 
affection upon irregularity of the uterine func- 
tion, are to be treated under this view of the 
subject. Hemorrhages and other morbid dis- 
charges, are to be dealt with by removing the 
cause when practicable, by diminishing vascular 
activity, or by quieting the discharging sur- 
faces with opiates, or contracting them with 
astringents. There is one class of curable dis- 
eases which are controlled chiefly by specific 
remedies, being in some instances suspended, 
in others radically removed. Thus, gout is re- 
lieved by colchicum, and intermittents by qui- 
nine and bark. Scabies is cured by sulphur, 
syphilis by mercury, goitre, as we are informed, 
by iodine, and various chronic eruptions by 
arsenic and con^Dsive sublimate. The foregoing 
examples will serve to illustrate, not only the 
power of medicine, but also the great variety of 
grounds which should govern medical practice, 
and the importance of an intelligent diagnosis, 
as well as a knowledge of therapeutic means. 

In the next subdivision, or that of self-limited 
diseases, we include those ' which receive limits 
from their own nature, and not from foreign 



88 TREATMENT OF DISEASE. 

influences, and which, after they have obtained 
foothold in the system, cannot in the present 
state of our knowledge be eradicated or abridged 
by art, but to which there is due a certain 
succession of processes, to be completed in a 
certain time, which time and processes may 
vary with the constitution and condition of the 
patient, but are not known to be shortened by 
medical treatment.' Examples are abundant, 
and are found in typhus and typhoid fever, 
measles, small-pox, hooping cough, dysentery, 
and many other diseases of lighter or graver 
character.* 

It is with regret that we are obliged to ac- 
knowledge the existence of a third class, that of 
incurable diseases, which has been recognized 
in all ages as the opprobrium medicorum. It 
includes the long train of internal morbid degen- 
erations, malignant and chronic, by tubercle and 
granulation, by atrophy and hypertrophy, soft- 
ening and hardening, scirrbus, encephalosis 
ossification, concretion, contraction and dilata- 
tion, with their various consequences of phthi- 
sis, emphysema, dropsy, epilepsy, paralysis, and 

* See marginal note f, page 19. 



TREATMENT OF DISEASE. 89 

a multitude of intractable disorders, in which 
organs are disabled, functions destroyed, and 
life itself rendered incapable of continuance. 

It is obvious that in the three foregoing classes 
of disease, very different modifications of treat- 
ment are required. In curable diseases, our 
remedial measures should be prompt and ener- 
getic in proportion to the emergency of the 
case, and the certainty of benefit which is to 
follow their employment. In self-limited dis- 
eases, our treatment must be of the expectant 
character. It consists in doing what we can 
for the comfort and safety of the patient, avoid- 
ing useless and troublesome applications, watch- 
ing against accidents and complications, and 
waiting for the salutary operations of nature. 
In those maladies which are in their nature in- 
curable, we are obliged to confine ourselves to 
the palliation of suffering, and the removal of 
causes which may aggravate the disease. 

Such, I believe, is the true exposition of the 
powers and duties of every medical man. The 
dignity of our science, and the responsibility of 
our profession, require that we should form just 
views of the extent of our capacity and duty. 



90 TREATMENT OF DISEASE. 

and that we should not shrink from avowing 
them to the world. Our science, imperfect as 
it is, has achieved as much as any similar sci- 
ence for the prevention, alleviation, and removal 
of the evils which it combats. Let us not bring 
it into disrepute, by pretending to impossibilities, 
by asserting what cannot be proved, and by pro- 
fessing what human art is unable to accomplish. 
A new era will dawn upon medicine when its 
faithful and enlightened cultivators shall more 
constantly devote their time and their efforts to 
enlighten the public mind in regard to the true 
mission and powers of their science ; and when 
they shall leave to charlatans and fanatics, the 
doubtful * and dishonest game of unfounded 
professional pretension. 



PRACTICAL VIEWS 



ON 



MEDICAL EDUCATION. 

PUBLI8HED BT TOTE 01 THB MEDICAL lAOULTY 07 HABYABD 
tJElVEBSITT IN 1860. 

The undecided state of public opinion in re- 
gard to some of the fundamental points in a 
course of medical education, including among 
other things the portion of the term of pupilage 
proper to be spent in attendance on lectures, is 
thought to justify a further consideration of the 
subject. In some of its relations, this subject 
has already been discussed, in the Transactions 
of the American Medical Association for 1849, 
in two reports, pages 353 and 359, to which the 
reader is particularly referred. The following 
condensed, but more general view of the subject 
of medical education, is now respectfully sub- 
mitted to the members of the Association. 



92 PRACTICAL VIEWS 

Medical instruction should be adapted to the 
power of students to receive and retain what is 
communicated to them, and should be confined 
to what is important to them in their subse- 
quent life. 

In modern times the constituent branches of 
medical science are so expanded, that they are 
not acquired by any physician in a life-time, 
and still less by a student during his pupilage. 
The same is true even of many individual 
branches. It is not, therefore, to be conceded 
that < a scheme of scientific instruction should 
embrace the whole science, and no part should 
be omitted;' nor that *a well-digested plan of 
lectures embraces all that is to be known and 
taught.' Medical science has at this day be- 
come so unwieldy, and contains so much that is 
unnecessary, at least to beginners, that the 
attempt to explain to students the whole, is 
likely to involve the result of their learning but 
little. 

In Chemistry, at the present time, a thorough 
adept is unknown. No man living knows all 
the recorded facts, or all that is to be known 
and taught, in that science. Organic chemistry 



ON BfEDICAL EDUCATION. 93 

alone fills large volumes, though yet in its 
infancy. 

In Materia Medica there are some thousands 
of substances and their compounds, which pos- 
sess what is called a medicinal power. Yet it 
is not probable that any physician eifectively 
reads the one half, or remembers one quarter, or 
employs in his yearly practice one tenth, of the 
contents of the common dispensatories. 

In Pathology, so complicated and various are 
the conditions attendant on the individual forms 
of disease, and their relations with idiosyncracy, 
temporary condition and external agency, with 
organic lesions and functional disturbances, that 
few of the most experienced pathologists can be 
said to understand their whole science, or to be 
always competent to its successful application. 

In Etiology, the theoretical literature of 
causes has spread itself out to an extent which 
is burdensome and unprofitable. It is true, that 
< man, from his nature, is subject to suffering, 
disease and death;' — but it is not equally ap- 
parent, that Hhe causes by which these con- 
ditions are produced, are ascertainable.' We 
know nothing of the vehicle of cholera or influ- 



94 PRACTICAL VIEWS 

enza, nor is it probably in the power of any 
physician, by any art or application of bis 
knowledge, to produce in a given healthy man 
a case of common pneumonia or of acute rheu- 
matism, of diabetes or Bright's kidney, of hyper* 
trophy or of cancer, or even of a common boil, 
or wart. 

In Therapeutics, many hundred volaroea 
exist, such as would not have existed, could a 
knowledge of the cure of diseases be made so 
easily tangible, that it could be spread befofe 
the student in the three or five years of his 
pupilage. 

In Anatomy, general and special, microscopic 
and transcendental; — in Physiology, with its 
intricate ramifications; — in Surgery, of which 
several subordinate specialities constitute dis- 
tinct living professions ; it is not to be admitted 
that the means or time of any ordinary course 
of lectures can furnish full and complete instruc- 
tion. Certainly it must be difficult to arrange 
a course of lectures on any of the extensive 
sciences which now constitute medicine, if it be 
indeed true, that Hhe teachers are not justifiable 
in suppressing any portion.' 



ON MEDICAL EDUCATION. 95 

It is the business of lecturers in medical 
schools, to condense and abridge the sciences 
which they respectively teach, to distinguish 
their essential and elementary principles, to sift 
carefully the useful from the superjfluous, and to 
confine the scope of their teachings, as far as 
possible, to what is true and profitable, and 
likely to be remembered and used by their 
hearers. It is unfortunately too true, that, * in 
an extended system of instruction, there is much 
that the student will not master, much that will 
have escaped his attention, much which he 
ought to know that he has not learned.' The 
remedy appears to be, to teach him well what 
he can and should master, and briefly to point 
out to him the sources, fortunately abundant, 
from which he may obtain the rest. 

Much injury is done to the cause of true 
learning by medical assumption, amplification, 
and exaggeration, by premature adoption of 
novelties, and by tenacity of theories, personal 
or espoused. Students, in all former years, 
have expended much time in learning, what it 
afterwards cost them both time and trouble to 
unlearn ; — in acquiring, not merely the truths of 



96 PRACTICAL VIEWS 

science, but the crade announcements and plau- 
sible doctrines of sanguine or ingenious men. 
How much time has been wasted in some of 
our distinguished seminaries, in acquiring the 
visionary and now neglected theories of Rush 
and Broussais ! 

The most commonly exaggerated branch of 
medical science is therapeutics. Enlightened 
physicians well know that many diseases are 
incurable, and that others are subject to laws of 
duration, which cannot be interrupted by art 
Yet students sometimes return from medical 
schools persuaded that their instructors know 
how to cure a large part of these diseases, and 
that if others are less fortunate, it is attributable 
to their own fault. 

Medical teachers should keep pace with the 
progress of their respective sciences. Yet in 
their haste for the promulgation of novelties, 
they should not omit to give the proper consid- 
eration to the older and more settled principles 
of science. Medical men are liable to commit 
the error of adopting premature opinions, un- 
sound practice and inconvenient changes of 
language and nomenclature, sometimes from a 



ON MEDICAL EDUCATION. 



97 



love of display, and sometimes from a want of 
self-reliance, and a fear of being thought behind 
the literature of their time. 

The length of a course of lectures is not the 
measure of its value to the student A course 
of lectures should not outlast the curiosity of 
its hearers, nor their average pecuniary ability 
to attend. Custom in this country has generally 
fixed the limits of these things at about four 
months. A comprehensive and judicious course, 
confined to the enforcing of necessary points, 
is far more profitable than a more discursive 
course to a wearied and diminishing audience. 

Lectures are chiefly wanted to impress by de- 
monstration the practical branches of science, 
and they are most effective in places where the 
facilities for such demonstrations can be com- 
manded. Anatomy requires extensive exhibi- 
tions by the teacher, and personal dissections by 
the student Chemistry and Materia Medica 
require illustrations by specimens and experi- 
ments. Pathology needs the aid of autopsies, 
museums and the clinical demonstrations of 
large hospitals. A knowledge of Obstetrics is 
not perfected without apparatus and practice. 
7 



98 PRACTICAL VIEWS 

Surgery is acquired by witnessing numerous 
operations, surgical diseases, illustrated expla- 
nations, and by personal practice on the dead 
body. Physical exploration is wholly demon- 
strative. A knowledge of auscultation can no 
more be acquired from books, or abstract lec- 
tures, than a knowledge of music, or of individ- 
ual physiognomy. 

Tlie intermediate period between lectures, 
should be spent by students in active and origi- 
nal study, approved and confirmed by regular 
recitations, and by such opportunities as can be 
commanded, for practical, personal experience. 
Private schools for small classes, and the privi^te 
teaching of individuals, who are suitably quali- 
fied and situated, are more advantageous for 
two thirds of the year, than either the fatiguing 
jostle of overcrowded rooms, or the listless rou- 
tine kept up by the survivors of a passive class. 

The usefulness of a medical school depends 
not so much on the length of its session, as 
upon the amount of education, preliminary and 
ultimate, which it requires, the fidelity with 
which it exacts its own professed requisitions, 
and the train of healthy exertion, active inquiry 



ON MEDICAL EDUCATION. 99 

and rigid, methodical, self-regulating study, to 
which it introduces its pupils. The longest 
lectures are of little use to students who want a 
common education, and whose medical educa- 
tion does not qualify them afterwards to observe, 
to inquire, and to discriminate. The exacted • 
evidence of three years of well-conducted study, 
is better than the exhibited ticket of a six 
months' course. 

The subjects most important to be well 
taught in medical schools, are the elementary 
principles which constitute the frame-work of 
medical sciences, and the mode of thought and 
inquiry which leads to just reasoning upon 
them. After these, most attention should be 
given to selecting and enforcing such practical 
truths, as will most certainly be wanted by the 
young practitioner, in his future career of 
responsibility. 

The things to be avoided by medical teachers 
are technicalities, which are unintelligible to 
beginners, — gratuitous assumptions and cita- 
tions of doubtful authorities, — prolix disserta- 
tions on speculative topics, — excessive minute- 
ness in regard to subjects which are intricate 



100 ON MEDICAL EDUCATION. 

and but little used, and therefore destined to be 
speedily forgotten. To these may be added 
controversies, superfluous personal euloginms 
and criminations, and all self*exaggeration, 
personal or local. 



REPORT ON HOM(EOTATHY: 

MADE TO THE COUNSELLOBS OF THE MASSACHUSETTS MEDICAL 
SOCIETY IN FEBRUARY, 1854. 

The committee appointed by the Counsellors 
of the Massachusetts Medical Society, to con- 
sider the resolution of the Essex North District 
Society,* and also that of Dr. Spofford, in rela- 
tion to the subject of Homoeopathy, beg leave 
to Report : — 

That the Massachusetts Medical Society was 
incorporated mainly for the purpose of estab- 
lishing a proper standard of medical education, 
and of insuring a competent degree of knowU 
edge among those who should be authorized to 
practise the profession of medicine in this Com- 
monwealth, and they are not aware that the 
Society possess any power to coerce men, after 

* These resolutions contemplated dissolying the connection of 
Homceopathists with the Society. 



102 REPORT ON HOMCEOPATHT. 

they have been thus educated and qnalifiedy to 
embrace, or renounce, any theoretical opinions, 
or modes of practice, which they may innocent- 
ly believe, or which, not believing, they may 
think it proper to profess. 

In medical science there are certain fdnda* 
mental laws relating to the structure and funo* 
tions of the body, and the morbid changes to 
which it is subject, also regarding the signs by 
which those changes are discovered, — upon 
which all well-educated physicians are agreed. 
But in certain provinces of medical science 
such fundamental laws, owing to the imperfec- 
tion of our means of knowledge, cannot at the 
present time be established. This is the case 
with Therapeutics, or the art of treating or 
curing diseases, in which the evidence required 
by science is difficult to obtain, and in regard to 
which writers and teachers, sects and individu- 
als, and even the same individual in the course 
of an ordinary life-time, may without dishon- 
esty entertain great diversities of opinion. 

The tendency of modern observation is such 
as to lead us to the belief that disease is less 
frequently under the control of remedial treat- 



BEPORT ON HOMCEOPATHY. 103 

ment than it was formerly supposed to be. 
Where observations are impartially made by 
competent persons, it is found that people re- 
cover, and also that they die, under all the 
ordinary modes of treatment. And the evi- 
dence collected from sources which are worthy 
of reliance, is not so abundant or satisfactory as 
to convince a reasonable man that any general 
system of practice can be relied on for the cure 
of all cases. Hence it is not surprising that 
diversities, contrasts, and even extravagances 
in practice, are embraced by the sanguine, the 
credulous, the uninformed and the interested, 
frequently based upon no better authority 
than accident, imperfect observation, or defec- 
tive power of judgment in the party who adopts 
them. 

The broadest division which has been recog- 
nized for centuries in the treatment of disease, 
is that which resolves the whole subject into 
the active and the expectant modes of practice. 
The first employs various interfering agencies 
in the management of the sick, — the last waits 
more on the unassisted course of nature, — and 
both have long had their exclusive advocates. 



104 REPORT ON HOMCEOPATHT. 

To the last of these divisions Homoeopaihy 
really, though not avowedly belongs. Its char- 
acter is, that while in reality it waits on the 
natural course of events, it commends itself to 
the ignorant and credulous by a professed intro- 
duction into the body of inappreciable quanti- 
ties of medicinal substances. Now the nugatory 
effect of such quantities is demonstrated by the 
fact, that in civilized life every person is exposed 
to the daily reception, in the form of solution, 
dust or vapor, of homoeopathic quantities of 
almost every common substance known in 
nature and art, without any appreciable conse- 
quences being found to follow. And the pre- 
tended exactness with which such nominal doses 
are administered by homoeopathic practitioners, 
is doubtless a fallacy, capable of producing in 
the living body no other effects than those which 
charlatanry has in all ages produced in the 
minds and bodies of imaginative patients. 

It is a fact much older than the institution of 
this Society, that visionary systems of practice 
have replaced each other in the faith of multi- 
tudes, at least several times in a century. And 
this will probably be the case, so long as prac- 



REPORT ON HOMGBOPATHY. 105 

tical medicine continnes to be, what it now is 
to a great extent, a theoretical and conjectural 
science. At the present period, among the sects 
usually called irregular, the homoeopathic sect 
prevails to a considerable extent in this country 
and in Europe. In the United States it is. 
exceeded only by the sect called Botanic, or 
Thompsonian practitioners, which at the present 
time appears, of the two, to number most disci- 
ples. It is not probable that the faith of either 
of these sects will be displaced by a return of 
their followers to any more enlightened or 
rational creed. Nevertheless, it is safe to pre- 
dict that they will both be superseded in the 
course of time by other systems, not more 
rational or probable in themselves, but possess- 
ing the attraction of greater novelty, or urged 
upon the credulous with greater adroitness. 
When the world, and especially the unen- 
lightened part of it, shall be settled in their 
opinions on other sectarian subjects, we may 
anticipate unanimity of opinion among them in 
the science of practical medicine. 

But it is not only to expectant medicine, in 
the form of its counterfeit, homoeopathy, that 



106 REPORT ON HOMOSOPATHT. 

the censnre of prejudice and credulity k to be 
attached. The opposite system of active prac- 
tice, carried to the extreme usaally called heroic, 
is alike chargeable with evil to the patients, 
whenever it becomes the absorbing and exdn- 
^sive course of the practitioner. Physicians are 
too often led to exaggerate the usefulness of the 
doctrines in which they have been educated, 
and especially of those by the exercise of which 
they obtain their daily bread. In such cases 
habit gets the ascendancy over enlightened 
judgment, and the man of routine, or of narrow 
views, asks himself, from day to day, what drug 
or what appliance he shall next resort to, instead 
of asking the more important question, whether 
any drug or any appliance is called for, or is 
properly admissible in the case. 

In Medicine, as in the other inexact sciences 
which deeply concern the welfare of mankind, 
enough has been learned to show that extreme 
measures, either of omission or of commission, 
are not, when systematized as a whole, produc* 
tive of benefit or safety to mankind. 

It is quite probable that the prevalence, at 
" *«s, of eccentric and ultra-sectarian doctrines 



REPOHT ON HOMGBOPATHY. 107 

in medicine, is attributable to the exaggerated 
value attached by physicians themselves to- in- 
cessant activity in practice, and an assumption? 
of credit for particular modes of medication, to- 
which, as such, they are not entitled. There is 
often a want of openness in the intercourse of 
physicians, both enlightened and ignorant, with 
their patients, who are requested to believe that 
their cure depends not in any degree on the 
salutary influences of nature and time, but in 
the rigid enforcement of a prescribed routine of 
practice^ either active or formal, as the case 
may be. And when opposite modes of treat- 
ment are urged upon the public by different 
practitioners with reasonings equally specious, 
it is not surprising that patients should some- 
times adopt that which is least troublesome in 
its operation. Neither is it surprising that they 
should sometimes embrace even a deception, 
which absolves them from their allegiance to an 
unnecessarily severe or troublesome course of 
t^atment. 

An honest and independent practitioner, and 
especially a member of the Massachusetts Med- 
ical Society, should never be induced to give 



108 REPORT ON HOM(BOPATHT. 

liis counsel, or his aid in any shape, to empiri- 
cism and dishonesty, whether it occur among 
those who are within or without the pale of its 
membership. And no consideration of gain or 
notoriety should induce those, whose age or 
standing cause them to be resorted to for ]con* 
sultation, to lend their influence or countenance 
to encourage either the delusions of those who 
-are honest, or the practices of those who are 
snot. 

If quackery, individual or gregarioas, is ever 
to be eradicated, or even abated, in civilized 
society, it must be done by enlightening the 
public mind in regard to the true powers of 
medicine. The community must be made to 
understand that there are certain things which 
medicine can do, and certain other things which 
it cannot do ; that some diseases are curable by 
active interference, and others by time and 
nature alone ; that true medical skill lies in dis- 
crimination and prognosis, and judicious adap- 
tation of management, more than in assumed 
therapeutic power, in regard to special agents ; 
and that he who professes to cure by medicine 
a self-limited fever, is as much an impostor, or 



REPORT ON HOM(EOPATHY. 109 

deluded man, as he who pretends to do the same 
thing with a fractured bone or incised wound. 
Nothing so much shakes the confidence of man- 
kind in the medical profession as unfulfilled 
promises ; nothing so much strengthens this 
confidence, as fair dealing exhibited in an earn- 
est requirement and fearless expression of the 
truth. Such a course, by commending itself to 
the sensible and enlightened, may be expected, 
sooner or later, in some measure to influ- 
ence the unreasonable and ignorant, — much 
sooner, indeed, than a warfare carried on in the 
arena of empiricism with its own weapons. 



ON THE MEDICAL PROFESSIOli 
AND QUACKERY. 

AN IirrRODVOTOSY LECTUBE, DELITIBED AT THE MKDIOAL 00^ 
LEGE, BOSTON, NOYEMBEB 6, 1844. 

I AM about to address myself to an audience 
of young men, a class of persons who, in onJ 
new and active country, assume an influence^ 
and wear a responsibility, unknown in the oldei 
communities of Europe. The sparse charactei 
of our population, the caD for active and efficieni 
men, the sure market which exists for talents, 
and even for common ability and prudence 
have given a national precocity to our youtb 
and a readiness in adapting themselves to ne^ 
and difficult spheres of action. I have hear 
foreigners speak with surprise of the arrival, i 
distant ports of Europe or India, of Americai 
ships commanded, not as is usual, by weathei 



ON THE MEDICAL PROFESSION. Ill 

beaten veterans, but by beardless striplings. 
The signs of our mercantile houses bear often 
the names of very young men, and the avenues 
of our professions are so crowded with them, 
that perhaps no regulation is more liable to be 
infringed than that which requires that profes- 
sional candidates shall be twenty-one years of 
age. Young men command the ranks of our 
inilitary corps and swell our political meetings. 
Their voice is heard among us in the periodical 
press and in the halls of legislation. 

These precocious habits of our country have 
of course been felt in the medical profession. In 
"lost of the schools of Europe, medical honors 
a^e not confenred until after a novitiate of four, 
and more frequently five years, during which an 
extensive circle of sciences is obliged to be 
*^astered, and to be approved by a series of 
strict examinations. Not only are the essential 
"Ranches of medicine required to be fully under- 
stood, but they must be preceded by a knowl- 
®^ge of the subsidiary sciences, and must also 
"^ confirmed by practical and clinical expe- 
rience. 

With us, on the other hand, the short period 



112 ON THE MEDICAL 

of three preparatory years devoted to regular 
study and lectures, may be said to constitute 
nearly the sum total of a medical education ; 
for the collateral requirements are so small that 
their acquisition is often effected during the 
same three years which are applied to the other 
branches. And a young man who has learned 
to read and write, issues from the village school 
or perhaps from the counter or the plough, and 
in three years is licensed, and declared compe- 
tent to exercise the multifarious profession of 
medicine and surgery in all its departments. 
As it often happens in this and similar cases^ 
the newly-approved candidate sends forth his 
anxious glance, directed not always to his own 
deficiencies or the means of supplying them, but 
to that common goal and object of a young 
man's inquiry, which is to fill up the measure of 
his practical aspirations — an opening. By the 
timely decease of some elderly practitioiier, ot 
by the fortunate discovery of a rising settlementi 
in some distant State, or on some promising 
water-power, he finds himself, perhaps at shc^ 
notice, installed, under virtue of the acquiescent 
silence of the small community in which he 



PROFESSION. 



113 



■titated physician of the place. In 
perhaps in one week, he may be 
diagnosticate organic lesion in a 
id death, or to treat the most for- 
ive disease. He may be sum- 
he femoral artery, or to decide and 
lof placental presentation. There 
rastdting physician within many 
none who can arrive in season 
BDcy. 

I then, and probably the lives of the 

^nstitaents of this young man, 

ipon the question whether he has, 

en truly educated, whether his 

ad have been adequately trained 

; occasions that await him. It is 

|iat he has suffered three years to 

dng his ease in the office of a 

L nor that he has passed a corres- 

I in following the rounds of a coun- 

. It is not enough that he has 

the works of approved authors, 

leezed through the customary aca- 

lation. If he has done only this, 

n probable that failure awaits on 

8 



114 ON THE MEDICAL 

himself and disaster upon his patient. But if 
his studies have been methodical, and conducted 
with an eye to practical application ; if he has 
concentrated his attention upon necessary 
points ; if he has felt the earnest interest which, 
more than anything else, imprints truth on the 
remembrance ; if he has gathered up and ar- 
ranged his resources in reference to coming 
emergencies ; if he has gone over in anticipation 
the difficulties of his profession, and planned bis 
own mode of extrication,— then he will find 
that inexperience does not involve failure, and 
that youth is not an insurmountable barrieir to 
success. He will recollect that the most emi- 
nent physicians and the most successful opera- 
tors have had their first cases. He will perhaps 
also remember, that some of the most distin- 
guished men in history have emerged from 
obscurity while yet in youth ; that not only 
warriors, like Alexander and Napoleon, but 
statesmen, like Pitt and Fox, and philosophers, 
like Davy and Bichat, had achieved some of 
their proudest laurels at the very entrance of 
manhood. 

Let it not be supposed, however, that I am 



PHOFES8ION. 115 

an advocate for the premature assumption, by 
young men, of the responsibilities of our profes* 
«ion. Evfery medical student is to be considered 
unfortunate, who by reason of poverty, or the 
stress of other circumstances, is obliged to hurry 
his probationary period to aji early termination. 
Too much time and attention are not often 
bestowed ' on the business of preparation for 
practice. The oldest and the best physicians 
have had frequent cause to regret that they 
were not better educated. But the superficial 
student, who rarely has the time and the will to 
repair his eaily deficiencies, is haunted through 
life by a round of perplexity and embarrass- 
ment, and degraded by a sense of his own 
incompetency. 

It should be borne in mind, that there is no 
period of life in which time can be so conve* 
niently spared firom lucrative pursuits, as in 
youth. After a man has atained to the age o£ 
thirty, it is commonly of very little consequence 
to him, as far as his fame and yearly receipts 
are concerned, whether he had commenced piac- 
tiee at the age of twenty-one or of twenty-four. 
But as far as he may prize a quiet conscience 



116 ON THE MEDICAL 

and freedom from anxiety, the later age is in- 
comparable the most secure. I would advise 
any young man, who has completed his educa- 
tion at the end of his minority, that he should 
devote two additional years, and if practicable, 
a still longer period, to availing himself of such 
advantages, both in study and practice, as may 
prepare him for his future duties. And when, 
as it often happens in our community, narrow 
circumstances require that a young man should 
live by his own exertions, this state of things, 
instead of being a motive that he should crowd 
himself prematurely into the ranks of the pro- 
fession, encumbered with debt, and bare of 
acquirements and of means, is rather an imper- 
ative reason that he should at once begin by 
resolving to devote twice the customary number 
of years, if necessary, to the double purpose of 
keeping himself in an independent position, and 
of placing himself at length, in point of maturity 
of knowledge, on a par with his more favored 
competitors. 

It may not be improper, in this place, to oflFer 
you some suggestions as to the mode in which 
students may advantageously appropriate the 



PROFESSION. 117 

time of their pupilage in reference to the science 
which they expect to acquire. Medical litera- 
ture has become so vast a subject, that the 
undirected student is apt to be lost in the maze 
of books and sciences which seem equally to 
press upon his attention. And he is likely to 
fall into the pernicious error of thinking that he 
must read a great deal, even though he remem- 
bers little. The true object of a medical 
pupilage should be, not to read, but to study, 
to observe, and to remember ; not to pass 
superficially over the writings of celebrated 
men, but to select those compendiums of the 
several sciences, which contain a condensed 
view of their essential and elementary facts, 
which separate the wheat from the chaff, and 
offer what is fundamental and useful, within a 
compass which is capable of being impressed on 
the memory. Most of the constituent sciences 
which are nominally included in a modern med- 
ical education, are now so extensive, that the 
cultivation of any one of them may afford 
abundant occupation for a common lifetime. 
Passing over the more elementary branches, I 
may instance the theory and practice of medi- 



118 ON THB MEDIOAL 

cine^ the literature of which is a vast magazine 
of rubbish, with a few gems imbedded in it, 
accumulated in all time since the origin of 
writing, and in such excess that no country in 
Europe could probably furnish even a catalogue 
of its own modern books. The history of this 
extensive science contains a mixture of much 
that is bad, with much less that is good. And 
although in medical research the still smalt 
voice of truth has from time to time made itself 
heard for a season, yet it has as often been 
drowned by the dogmas of the visionary and 
the clamors of the interested. During the }»re8» 
ent century a host of theorists and gratuitous 
reformers have replaced each other on the arena 
of medical controversy. But we have seen that 
while a truth in medical science, like the import 
of the physical signs for example, struggles its 
way through opposition and distrust into gene^ 
ral adoption, — an unfair and unfounded as« 
sumption rarely survives long the life of the 
individual whose own eloquence and obstinacy 
were necessary to force it for a time upon the 
public attention. 

If we could purge the sciences of pathology 



raOFEBBIOK. 119 

and tiicnpeiitieB from ihe wiitiiigs of men who 
"VTote merely becanse -^ley had a reputation to 
aoqnire or a doctcine to establish; and could 
oonfiiae these scaenoes to the results attained by 
those wiio sought duecdj and impartially for 
the true and the useful ; it is probable that the 
irhole Bubjeet j^ould be brought within the 
eamprehension, not only of every physiciaa, but 
of erery^ medical student And &om the recent 
waode of oonductittg medical inTestigations, 
which has commenced and is gradually gaining 
fiootfaold in all civilized countries, we may hope, 
m our own day, to see near approaches to this 
desirable result. 

Every medical man, whether student or phy- 
sician, owes a threefold duty, to himself, to his 
coB^petEtom, and to his patients. To himself 
he owes the cultivation of habits of order and 
pecKveranoe, a love of honesty and a desire of 
knowledge. No man is successful in a learned 
pvoiession, who does not cultivate a methodical 
^ipoaition of his time. The neglect of an hour, 
tiie omission of an engagement, and the post- 
ponement of what is necessary for what is 
wumportant, have ruined many a good inten- 



120 



ON THE MEDICAL 



tion and many a promising prospect. Lord 
Chesterfield says, that the Dake of Newcastle 
lost half an hour in the morning, and spent the 
whole day in running after it. This is a. true 
expression of the career of a busy but inefficient 
man. He who is always driven, always in a 
hurry, always late, and always with deficiencies 
to be made up, is very likely to be always a 
failure. It is well known that the responsi- 
bilities of society are best and most easily 
discharged by those who estimate the value of 
small portions of time, who do things strictly 
in their proper season and place, who provide 
against contingencies, and distribute their day 
in reference to what is, as well as to what may 
be required of them. 

But the best ordered arrangement of time, 
and the most punctual habits of attention, do 
not always succeed in our profession, except 
through perseverance, and often through long 
suffering. The public, especially in cities, are 
slow in giving their confidence to strangers and 
to young men. The late Dr. Physick, of Phila- 
delphia, asserted that during the first three 
years of his practice he did not pay for his shoe 



PROFESSION. 121 

leather; and a late very eminent physician of 
this city once informed me, that he did not 
earn his own board during three times that 
period. The conservative principle which retards 
the reception of young men into lucrative busi- 
ness, is the foundation of their security in after 
lijfe, for medical practice would not be worth 
having, in a community whose love of change 
should lead them to desert their former friends 
and counsellors, to run after every new comer. 
Physicians usually come on to the stage and 
move off of it, in company with the generation 
to which they belong. In a large city, a young 
physician, except under circumstances of pecu- 
liar patronage or necessity, does not usually ob- 
tain employment from families who are much in 
advance of himself. Sut these families and their 
medical attendants pass away, and he and his 
cotemporaries become the standing practitioners 
of their time. A preparatory period in the mean 
time elapses, during which the candidate for ^ 
future honors has usually enough to do, to per- 
fect his knowledge, to fill the gaps in his expe- 
rience, and to give proofs to the community 



123 ON THE MEPIOAL 

around him, that he possesses aptitade for the 
common affairs of life. 

Every physician is an inquirer during life, 
and continues to learn something up to the last 
year in which he may happen to study or prac- 
tise. As the science advances, moreover, every 
intelligent practitioner is obliged to replace some 
of his former opinions with others, which he 
finds to be better substantiated. We should be 
careful, therefore, not to pledge ourselves unne- 
cessarily to medical opinions which are founded 
on equivocal or imperfect testimony. The pub* 
lie sentiment attaches a kind of disgrace to 
frequent changes and recantations, and theji 
ought also to do the same to the course of any 
man, who for the sake of consistency with him- 
self, continues to maintain an erroneous and 
exploded opinion. Both these extremes are 
avoided by the physician who reserves his assent 
to any new opinion, until the evidence of the 
case is satisfactorily made out. 

One of the most difficult virtues for a physi- 
cian to cultivate, is a just and proper deportment 
towards his professional brethren. As in all pro- 
fessions in which men live by their heads rather 



PROFESSION. 123 

than their hands, business is liable to be over- 
done, and a candidate who has not acquired all 
the occupation that he wishes, is apt to regard 
his competitors as stumbling-blocks, to be gotten 
rid of by fair means, or foul. Hence arise the 
jealousies, calumnies, and open hostilities so 
often entertained, which injure all the parties 
concerned, and lower the estimation of the pro- 
fession with the public. Harmony and a proper 
esprit du corps, may uphold the dignity of even 
an inferior profession ; but the public rarely re- 
spect any class of men, the members of which 
have no respect for each other. A friendly in- 
tercourse with those whom we approve, is pro- 
ductive of pleasure and advantage, and a gen- 
tlemanly forbearance towards those with whom 
we do not agree, will show that we are above 
jealousy. A man is always to be suspected, 
who tells you that he is surrounded with ene- 
mies ; and one who is an habitual calumniator 
of others, forces upon his hearers the conviction 
that they in their proper turn are to come in for 
their share of his animadversions. 

I doubt if physicians do not sometimes injure 
themselves and their cause, by showing too 



124 QUACKERY. 

great a sensitiveness in regard to the temporary 
inroads of irregular practitioners. Quackery 
whether carried on by the audacious enterprise 
of an individual impostor, or upheld by the 
trumj^eting of a fanatical sect, is to be consider- 
ed a necessary evil inherent in the constitution 
of society. It exists in every walk and occupa^ 
tion of life, by the exercise of which men pro- 
cure bread. The pettifogger in law, the M illerite 
lecturer in theology, the demagogue in politics, 
the system-monger in education, and the won- 
der-worker upon the brains and bowels of infat- 
uated audiences — what are all these but quacks 
moving in their respective spheres, and fattening 
upon the credulity of dupes. A certain portion 
of mankind are so constituted that they require 
to be ridden by others, and if you should suc- 
ceed in unhorsing a particular impostor, it is 
only to prepare the saddle for a fresh and more 
unflinching equestrian. It is not good policy to 
say or to write too much in regard to the pre- 
tensions of impostors. A celebrated author ob- 
serves that *many a popular error has flourished 
through the opposition of the learned.' * By 

* Molntosh. 



QUACKERY. 125 

throwing the gauntlet at an insignificant man^ 
you at once raise him to the dignity of being 
your competitor, and acknowledge him as a 
*foeman worthy of your steel.' And if you dis- 
cover uneasiness, resentment, or ill temper, the 
public conclude that you -are influenced by your 
private interests. Besides, when you have en- 
tered the arena of controversy, you will probably 
find that the quack, who has his all at stake, 
can afford more breath and time than you can 
conveniently spare from your other occupations, 
and in an active warfare, he may acquire two 
partisans to your one. It is not long since the 
cxhibiter of a stuffed mermaid succeeded in 
drawing down the popular indignation on an 
unfortunate naturalist, who had ventured to 
declare that it was made of a fish and a monkey. 
The public generally require time to get dis- 
abused of a favorite error ; and if too abruptly 
assailed, they will sometimes hold on to it, as 
fte traveller did to his cloak when attacked by 
^te north wind. 

In your demeanor in regard to quacks, you 
sliould keep aloof from them, and trouble your- 
selves little about them. Admit the general 



126 QUACKERY. 

fact that the race always do, and mnst exist in 
society ; that they are wanted by the credulity 
of a particular class of minds ; that the fall of 
one dishonest pretender, or one visionary sect, 
is sure to be replaced by the elevation of an« 
other ; therefore it little concerns you to know 
what particular imposition has the ascendency 
at any given time. When you are interrogated 
in regard to a specific subject of this kind, yon 
should make a reasonable, cogent, and dispa^ 
sionate answer, always avoiding the appearance 
of warmth and especially of self-interest; and 
you may be sure that a majority of the public 
will be on the side of truth. As far as. my ob- 
servation extends, three quarters at least of the 
families in Boston and New England, are in the 
hands of regular practitioners. The remaining 
fraction, more or less, consists partly of mindd 
so constituted that they require the marvellous 
as a portion of their necessary food, and partly 
of unfortunate beings, suffering the inevitaUe 
lot of humanity, who having failed to obtain 
relief from the ordinary resources of medicilie, 
seek for temporary encouragement in the dishon- 
est assurances of any who will promise to cure 



QUACKERY. 127 

*thein. The first class is the dog in the fable, 
catching at shadows ; the last is the drowning 
fimii catching at straws. 

Above all, if you would discountenance 
quackery, take care that you become not quacks 
yourselves. Charlatanism consists not so much 
in ignorance, as in dishonesty and deception. 
In your intercourse with patients, cultivate a 
spirit of fidelity, candor and truth. Endeavor 
to understand yourselves and your science, 
weigh justly your own powers, and profess only 
what you can accomplish. If you announce to 
your patients that you will cure incurable dis- 
eases, or cut short those which have a necessary 
period of duration, you do not speak the truth, 
you merely blind your patient, while you throw 
tlte die for a fortuitous result, a game at which 
^^ veriest mountebank may at any time beat 
you. The profession as a body are often unpo- 
pular with a large and sagacious part of the 
community, because they so frequently disap- 
point the expectations they have allowed them- 
selves to raise. You may safely undertake and 
Promise to cure diseases which you know to be 
curable, to alleviate others which you know to 



12S ON THE MEDICAL 

be not 80, and to perform what art and. science 
can do towards conducting doubtful and dan- 
gerous cases to a happy issue. But this is all 
you can accomplish or promise. The skilful 
mariner may steer his ship through a dangerous 
navigation, but he cannot control the wind nor 
arrest the storm. Nor would he gain reputation 
by professing to do so. 

It is hardly necessary that I should counsel 
you not to neglect your patients, when you 
can do anything for their welfare and security. 
Neglect of outward attentions is not, I think, a 
very frequent sin of physicians, inasmuch as 
their interest very obviously lies in a different 
course. But many practitioners fall into the 
opposite error of over-attention to their patients, 
of making them long, tedious or superfluous 
visits, of hampering them with strict and com- 
plicated instructions, and especially of over- 
drugging them with remedies. There are some 
patients, it is true, who like to be bled, blistered 
and physicked ; but the number is small, and in 
most cases both the instinct of the child, and 
the discretion of the grown man, cause them to 
revolt against nauseous and painful inflictions. 



PROFESSION. 129 

Vhen, therefore, you are called to take charge 
f a case, ask yourselves how great is the dan- 
;er, and what is the probable tendency of the 
lisease, if left to itself. If life is in question, 
ind you have reason to believe that the patient 
may be rescued by prompt and energetic reme- 
dies, you should not hesitate to employ them. 
But in common, trivial and safe cases, such as 
afford a large part of a physician's occupation, 
you should not allow a habit, or a hobby, to 
lead you into the blind routine of always think- 
ing that you must make your patients worse 
l>efore they can be better. I believe that much 
of the medical imposition of the present day is 
sustained in places where practice has previously 
been over-heroic, and because mankind are grat- 
ified to find that they and their families can get 
well without the lancet, the vomit and the blis- 
ter, indiscriminately applied; and because the 
adroit charlatan transfers the salutary influences 
of time and nature, to the credit of his own less 
^agreeable inflictions. 

It is the duty of physicians to elevate their 
profession, by maintaining in their individual 
character a high moral rectitude, a just and 
9 



130 



ON THE MEDICAL 



I 



honorable conduct, a devotedness to the welfare 
of their patients, and an unceasing effort to 
improve themselves and their science. K this 
course is pursued by medical men, they can 
hardly fail of becoming useful and respected 
members of society. There is no country in the 
world in which the avenues to respectability 
and distinction, to competency, and even to 
wealth, are more open to physicians, than in the 
United States. It has been observed that in 
England, no medical man is ever permitted to 
attain the aristocratic rank, which belongs to 
birth, and which is occasionally accorded to 
eminence in the military, political, legal and 
financial professions. But in our country there 
is no post of honor or emolument, and no situa- 
tion of influence and distinction, which our his- 
tory does not show to be within the reach of 
our profession. But it is not to political, or 
extra professional preferment, that the true phy- 
sician should look. He should rather be con- 
tented to build up bis own character within his 
own sphere, as a man of knowledge, fidelity 
and honor. The respect of the community, and 
the attachment of friends, will always attend on 



ON 



GOUT AND ITS TREATMENT. 



Gout, technically known by the names of 
Arthritis and Podagra, is a painful, inflamma- 
tory disease, appearing by paroxysms, affecting 
chiefly the smaller joints, but liable to change 
its seat to various more important organs. It 
is hereditary in its character, and affects the 
luxurious more than the laboring and abstemi- 
ous classes. It seldom occurs in children, but 
makes its appearance most commonly in middle 
or advanced life, and affects men more frequent- 
ly than women. 

The most common place for the primary at- 
tack of gout is in the first joint, or ball, of the 
great toe of one foot. The patient, in many 
cases without previous indications of illness, is 
Rnronsed at being awakened in the middle of 



ON GOUT. 133 

e night, or a little later, by intolerable pain in 
lat joint, with much febrile heat and restless- 
sss, commencing, perhaps, in a slight chill. 
^he toe-joint soon becomes swollen, tense and 
ed. Sometimes the ankle, heel, or instep is 
similarly affected. There is exquisite tender- 
ness on the slightest pressure, or motion of the 
part This state of things continues from six to 
twenty-four hours, after which a remission of 
pain takes place, with gentle perspiration, and 
tendency to sleep. The inflamed joint, however, 
continues to increase in swelling, and at length 
becomes oedematous and shining. On the fol- 
lowing night the pain and fever return, and so 
continue to do for a week, more or less, during 
^Mch there is thirst, want of appetite, costive- 
'^^s, and scanty high-colored urine depositing 
^ ^*ed or lateritious sediment on cooling. 

The paroxysm lasts ordinarily from three to 
^^ days, at the end of which time the pain sud- 
denly terminates, as if by magic. The joint 
continues swollen and oedematous for a few 
^^ys, with itching and exfoliation of the cuticle, 
"^t the patient returns to his accustomed health 



134 ON GOUT. 

with perhaps an unwonted degree of vigor and 
alacrity. 

A precursory stage in most persons takes 
place in advance of the paroxysm. It is mark- 
ed by a deranged state of the appetite and 
digestion, by heartburn, nausea, flatulence, and 
offensive alvine discharges, also by languor^ 
headache, low spirits and disturbed sleep. 

The first paroxysm of gout is the almost cer- 
tain prelude to others, which are to follow after 
an interval of some months or years, according 
to the predisposition and habits of life of the 
patient. Some persons escape with two or 
three paroxysms only during life ; others have 
an annual visitation, and others are attacked 
once in two or three months. The frequency of 
the paroxysms goes on increasing, until in some 
patients there is hardly any respite, unless for a 
few months in summer. The later paroxysms, 
however, are often more supportable, but the 
general health is more impaired than in the 
earlier attacks. 

In the later attacks both feet are liable to be 
affected in succession, and the inflammation, 
after having left one foot may return to it again. 



ON GOUT* 1S5 

The small joints of the hand are also subject to 
the invasion) constituting the variety of gout 
called chiragra. In inveterate cases, there is 
scarcely any joint of the body which may not 
participate in the extension of the disease. 
Effusion generally takes place into the synovial 
cavities, and adjacent cellular tissues. 

When the disease has become thus confirmed, 
it is usually called chronic gout This common- 
ly follows the acute form, but in some cases 
may become gradually established without it. 
In chronic gout the affected limbs are disabled 
for exercise, they become painful at night, in- 
terrupting sleep, and are moved by the patient 
^th difficulty and caution. There is also a 
general deterioration in the strength and spirits, 
the patient looks worn, sallow and haggard, the 
^gestive powers are deranged, and there is 
often palpitation and dyspnoea. 

When the disease has existed for a certain 
length of time, there appears in some persons, 
^^t not. in all, a deposit of calcareous concre- 
tions, known by the name of chalk stones, situ- 
ated mostly in the cellular tissue, between the 

outside of the joint and the skin. Sometimes, 



136 ON GOUT. 

however, they penetrate the fibrous textures and 
the cavities of the joints. These concretions 
are fluid, or semifluid, when first effused, but 
become gradually solid by the absorption of 
their fluid parts. They finally become hard 
and friable, resembling common chalk in their 
appearance. In their more fluid state they are 
formed of hydrated lithate of soda, but the 
solid concretions consist mainly of lithate of 
soda, with some phosphate of lime. 

The chalky concretions are liable to grow 
with the return of every paroxysm. In bad 
cases the skin finally gives way, and a chalky 
serous fluid is discharged. This is afterwards 
, replaced by a kind of chalky pus, and in this 
manner a part of the chalk escapes, but never 
the whole,, owing to its entanglement in the 
cells and textures. Persons have been known 
to write their names with the denuded chalk 
protruding from the knuckles. Sometimes the 
apertures close over and cicatrize, but are liable 
to break out again during subsequent parox- 
ysms. Chalk stones are most common in the 
joints of the hands and feet, which they distort 
in an unsightly manner. They may, however, 



OK GOUT. 



137 



^ 






P 



appear in any part which happens to be the 
seat of gouty inflammation. 

Persons who are subjects of gout are also 
liable to gravelly complaints, and to calculus 
both of the kidneys and bladder The urine is 
found not only to contain urea and the other 
solids in excess, but deposits lit hie acid and 
Itthate of soda. The nephritic complaints gene- 
rally supervene after the gout has lasted some 
time, and the paroxysms of the two complaints 
rather alternate than coincide with each other. 

In regard to the causes of gout, it is, in the 
first place, an hereditary disease* A majority 
af persons affected with it can trace the predis- 
position to their parents or ancestry. It does 
not follow, however, that all the children of 
gouty progenitors have the disease. It some- 
times leaps over one generation and appears in 
the next, and it is frequently kept off in those 
who are disposed to it, by an active and abste- 
mious life. "When gout and gravel affect the 
same person, it often happens that some of the 
children inherit the one, and some the other 
disease, alone. 

Grout rarely if ever appears before puberty* 



138 QN GOUT. 

In the statistical accounts collected by Sir C. 
Scudamore, it appears that the greatest number 
of first attacks came on between the ages of 
thirty and forty. But although the number 
which begun in persons above forty was some- 
what smaller^ it is evident that if averaged upon 
the whole number of persons actually living, 
above that age, the proportion would be greater. 

Gout occurs more frequently in men, than in 
the female sex. Yet women are by no means 
exempt from it, and in them it is most apt to 
appear after the cessation of the catamenia. 
The stout and corpulent, of both sexes, are 
more liable to it, than those of the opposite 
conformation. 

The cause which ia undoubtedly most active 
in the production of gout is a luxurious Ufe, 
with the free use of vinous liquors. Persons 
who take little exercise, and indulge largely in 
the pleasures of the table, especially in animal 
food and fermented drinks, are the most com* 
mon subjects of the disease. Among persons 
who are addicted to the excessive use of alco- 
holic liquids, it is observed that gout occurs 
much more frequently in those who consume 



ON GOUT. 13ft 

wine and malt liquors, than in those who are 
intemperate in distilled spirits. The disease is 
more common in England than in this country, 
and occurs much more frequently among the 
wealthy and luxurious, than among the poorer 
and laborious classes. 

There are various exceptional forms, under 
which the gouty diathesis may become appar- 
ent m the system. Sometimes the viscera be- 
come deranged, without obvious affection of 
the joints, constituting irregular or concealed 
gout Thus the digestive tube may be affected 
with nausea, want of appetite, pain, flatulence, 
costiveness, or diarrhoea, acid eructations, and 
6ven vomiting. In the thorax are sometimes 
fdt pain, dyspnoea and palpitation, and in the 
head, vertigo, diminutioh of sight and hearing, 
with headache, and sometimes numbness and 
lethargic heaviness. The spirits are excessively 
dejected, and the mind peevish and irritable. 
Sometimes the gouty inflammation attacks the 
^ye, the fauces, or the urethra, producing symp- 
toms imitative of various diseases. 

The name of retrocedent gout is applied, 
^hen the disease, by a sudden metastasis, dis- 



140 ON GOUT. 

appears at once from an inflamed joint, and 
attacks some internal organ with violent and 
alarming symptoms. The part most commonly 
seized is the stomach, in which there is sudden 
pain, with perhaps nausea and vomiting, and 
great anxiety and distress. The heart may also 
be attacked with syncope and urgent dyspnoea, 
or the brain -with symptoms of apoplexy and 
paralysis. 

The prognosis of gout is not unfavorable in 
the early stages, and so long as it keeps to the 
extremities. But the retrocession of the disease 
to the stomach, the heart, or to the brain and its 
membranes is fraught with considerable danger. 
The prevalent notion that gout secures an im- 
munity from other diseases, is now generally 
admitted to be founded in error. All that can 
be said to be true is, that many anomalous 
symptoms, both local and constitutional, which 
depend on concealed or atonic gout, and which 
may have harassed the patient for a long time, 
suddenly give way, when the gout declares 
itself in the form of a regular paroxysm in the 
foot. 

In its diagnosis gout is principally liable to 



ON GOUT. 141 

be confounded with rheumatism. The following 
drcumstances will serve to distinguish them. 
Gout affects the small joints, principally of the 
great toe. Acute rheumatism attacks chiefly 
the large ones, and often many at a time. In 
gout, the inflamed joint is of a vivid red color, 
it afterwards becomes oedematous, and ends 
with peeling off* of the cuticle. In rheumatism 
the joints are less red, and the cuticle does not 
desquamate. Gout is more paroxysmal in its 
character, and alternates with intervals of ease, 
Riore than rheumatism. The chalky deposits 
We characteristic of gout, the acid perspirations 
of rheumatism. Gout is hereditary, affects the 
loxurious and indolent, and appears after pu- 
'^erty. Rheumatism is less distinctly hereditary, 
^nd may affect persons of all ages, classes and 
occupations. 

The above diagnostic marks appear to me to 
constitute a legitimate distinction between the 
diseases of gout and rheumatism. It is but 
just however to state, that these distinctive 
characters are liable to numerous exceptions, 
^ud that some of the best French pathologists, 
such as Chomel, GrisoUe and Requin, deny the 



142 ON GOUT. 

diversity of the two diseases. And experienced 
physicians are sometimes at a loss to which of 
these forms of disease they shall assign particu- 
lar cases which exhibit the characteristics of 
both. 

The treatment of a first paroxysm of gout 
may be expectant and palliative, for it is not 
certain how soon spontaneous resolution will 
arrive, and the patient, not without reason, is 
taught from day to day to look for relief and 
restoration to health. Little, therefore, need be 
done except to open the bowels with some 
efiectual laxative, and to apply flannel with 
camphorated oil, or some opiate liniment. Bat 
when paroxysms are protracted and very pain* 
ful, or return with progressive severity, relief 
must be sought firom such means as are in 
our power. Many expedients have been re* 
sorted to, a large portion of which are liable 
to serious objections. Immersion of the foot 
in cold water has afforded great relief to the 
pain, but is liable to drive the gout to vital 
organs. Bleeding has been found to mitigate 
the inflammatory action, but is inadmissible ex- 
cept in the most robust and plethoric. Leech* 



ON eouT. 143 

iflg the afflicted joint is an asefnl palliative, 
bat even this has its limits of expediency. 
Varioas purgative mixtures have in turn ob« 
tained and lost a specific reputation. 

The remedy which, in the present century, 
has taken precedence of all others, is Colchi- 
cun. This drug, supposed to be the basis of 
9 French gout medicine called ea/u medicinale^ 
has justly acquired reputation for the power of 
putting an immediate stop to the paroxysm. 
Five grains of the powdered root, or three 
of the powdered lieeds, or from thirty to forty 
minims of the wine of colchicum root, may 
betaken three times in a day by a vigorous 
^ult If the medicine is good, it commonly 
purges in twenty-four hours, and sometimes 
produces vomiting, with prostration of strength, 
*niall pulse, and cold perspiration. These ef- 
fects give evidence of the full action of the 
'Jiedicine, but are not always necessary to the 
cute of the gouty paroxysm. They disappear 
^fter the colchicum is omitted. 

But the arresting of the paroxysm does not 
Evolve the cure of the disease. This more im- 
portant result requires the avoidance of the 



144 ON GOUT. 

cause of the eviL The preTention of fiitiiie 
paroxysms can only be expected from a caieM 1 
and rigidly abstemious r^men, and this oonne, 
I am happy to believe, will be found effectual 
in a great majority of cases. I have known 
various examples of persons who had been 
severely and repeatedly attacked with gout, yet 
who have been able to ward off sabsequent 
attacks indefinitely, by combining a life of ex- 
ercise with total abstinence from vinous and 
stimulating drinks. This method does not al- 
ways succeed in confirmed chronic gout, but in 
preventing the returns of the acute disease it 
is eminently successfuL And although in ce^ 
tain cases where the structure and secretions 
have become radically changed by the arthritic 
diathesis, there is little hope of perfect cure 
from any treatment, yet in the early, and some- 
times even in the advanced stages of this mal- 
ady, the recurring paroxysms are postponed, 
mitigated, or totally prevented by entire absti- 
nence from vinous and alcoholic stimulants. I 
have the happiness to be able to allude to va- 
rious cases of gentlemen well known in this 
city, in some of whom gout has been heredi- 



ON GOUT. 145 

tary, in others of long duration and great se- 
Yerity, as in those abready cited on page 49, in 
whom an almost perfect exemption from gout, 
of indefinite continuance, has followed an entire 
avoidance of stimulating liquids. 



10 



\ 



fi 



I 



ON THC 



TREATMENT OF INJURIES 

OOOAUONKD BT 

FIRE AND HEATED SUBSTANCES. 

BEING VAB.T OF ▲ BOTLSTON PRIZE DISSBBTAnON FOB 1819. 

The application to living textures of sub- 
stances which are heated beyond a certain tem- 
perature, is followed by the phenomena of pain 
and inflammation. The pain is of a peculiar 
kind, resembling that from the continued appli- 
cation of fire to the part ; the inflammation has 
a great tendency to suppurate, and often leaves 
a contracted cicatrix. 

The communication of an excess of caloric 
to animal bodies, whether living or dead, is fol- 
lowed by certain changes. Of the fluids some 
are coagulated, others are decomposed or even 
vaporized, if the heat be sufiicient. The solids 
are in a greater or less degree expanded, disor- 



INJURIES BT FIBE. 147 

ganized or decomposed ; according to their 8us« 
ceptibility of change and the quantity of caloric 
received. These processes in the living body 
being incompatible with its healthy condition, a 
morbid state of the part affected necessarily 
ensues. This state is marked by pain, rednessy 
swelling, vesication, suppuration, or mortifica« 
tion ; according to the degree and extent of the 
injury suffered. 

The distressing effects of these injuries, when 

they exist in an extensive degree, are exceeded 

by few diseases. Very dangerous cases often 

occur in children, whose clothes are accident- 

i ally kindled; in intoxicated persons, who fall 

i into the fire ; and in those exposed by confla- 

M giations, or by explosions of gunpowder, steam 

^\ boilers, and the inflammable gases of mines. 

^^1 The peculiar appearance of a burnt surface has 

commonly been supposed to require a peculiar 

cai^ teatment; and many practitioners, instead of 

,is: resorting to the general remedies of inflamma- 

ss tion, have placed their reliance on the supposed 

r e^: powers of specific remedies. In this way differ- 

sc^ cnt and opposite modes of treatment have been 

(&i adopted, whose apparent success or failure at 



148 TREATMENT OF 

different times has occasioned disputes respect* 
ing their comparative efficacy. After a varidy 
of trials have been made, and a multitude o* 
cases detailed, the practice still remains unto* 
cided ; and methods of treatment diametrically 
opposite enlist nearly an equal number of adv(>* 
cates. 

The two modes of treating burns and scalds 
which have recently acquired the greatest shaJ^ 
of notice, are those of Mr. Kentish and of S^ 
James Earle. The former of these consists i^ 
the use of stimulant, the latter of cooling appli** 
cations. 

Mr. Kentish recommends that the injure^ 
surface be in the first place washed and bathe^ 
with rectified spirit of wine, spirit of turpentin^^ 
or some similar application, which has bee^^ 
previously heated as far as it can be borne wit^^ 
the finger. After this bathing has been rt^ ^ 
^ peated two or three times, the whole is then t^^ 
be covered with plasters made of commo^^ 
basilicon or resinous ointment, thinned to th^^ 
consistence of a liniment with spirit of turpen^-' 
tine. This dressing is to be continued fc^^ 
twenty-four hours, after which its place may b» "^ 



INJURIES BY FIRE. 149 

supplied with some less stimulating substancci 
stich as proof spirit or laudanum, with the 
coldness taken off. At the end of forty-eight 
bonis, Mr. K. observes, the inflammation will 
ST^nerally be found to have disappeared, at 
W"hieh time the part may be dressed with cam- 
phorated . oil, with Goulard's cerate, or with 
cerate of lapis calaminaris. 

Ihe internal treatment recommended by Mr. 
Kentish is also stimulant Wine, ale, alcohol 
ox* laudanum, are advised to be used according 
to circumstances. 

Sir James Earle, in a publication, entitled 
' An Essay on the Means of lessening the Ef- 
fects of Fire on the Human Body,' defends a 
mode of treatment directly the reverse of the 
former. This consists of the antiphlogistic regi- 
men internally, together with the application of 
cold in the form of water, snow, or pounded ice, 
*o tie part affected. Sir Walter Farquhar and 
^'' Kinglake advocate the same mode of pro- 
^QUre; and the cases related to substantiate 
® happy effect of the cooling treatment are 
^* less numerous than those in favor of the 
^'^ointhinate remedies. 



150 TREATteENT OF 

The disputes on the comparative efficacy of 
the foregoing plans of treatment have been agi- 
tated with so much warmth and so little impar- 
tiality, that the reader of them is like to end his 
inquiries in scepticism rather than conviction. 
Inconsistent and opposite facts are often stated, 
and the same cases distorted to prove both 
points of the dispute. For instance, the re- 
markable case of Boerhaave, who was violently 
scalded by the bursting of Papin's digester, and 
who got well under copious bleeding and purg- 
ing, is cited by one as an instance of a speedy 
and fortunate cure, and by another as a tedious 
and difficult recovery, which might have taken 
place in half the time under a different mode of 
treatment The source of this uncertainty 
seems, firstly, to consist in making practical de- 
ductions from individual or insulated casesj 
which do not afford sufficient room for a com- 
parison of the effect of different remedies. Such 
is the idiosyncrasy of different constitutions, and 
so deceptive the appearance of different injuries, 
that it is often impossible to pronounce in what 
degree two cases resemble each other, and in 
what degree any application has actually expe- 



I 



INJURIES BT PIRE. 151 

dited or retarded the cure. According to the ca- 
price or prejudice of practitioners the account of 
^ case may be warped and colored in such a 
banner as to prove any point of a dispute that 
's wished. For example, should any one come 
^orth as the advocate for a negative mode of 
treating burns, which should consist in letting 
Aem alone, or in leaving the process to nature ; 
there is no doubt that in due time he would be 
*ble to collect a sufEcient number of apparently 
^tisfactory cases to answer all his purposes. 
The multitude of oases brought forward by Mr. 
Kentish and his opponents, in the aggregate, 
seems only to prove, that oil of turpentine and 
^^Id water are both salutary, and both perni- 
cious, according as the practitioner who watch- 
ed their influence, was under the prejudices of 
8- favorable or unfavorable nature toward either 
application. A second ground of error is like- 
"^^se contained in the supposition that a single 
a-n.cl specific mode of treatment can be accom- 
taodated to all states and degrees of the injuries 
occasioned by fire. 

It is obvious that many more cases may yet 
be detailed, which will not bring the question, 



152 TREATMENT OF 

in the least, nearer to a decision. Though a 
series of observations, by a faithful and intelli- 
gent practitioner, is entitled to respect, yet 
when two su6h courses present us with results 
diametrically opposite, we are justified in doubt- 
ing the validity of the ground on which they 
are founded. 

It occurred to me, that could a measure be 
devised, of inflicting two equal burns on cor- 
responding parts of the same animal, which 
should afterward be treated with different ap- 
plications, that a chance would be afforded of 
testing the comparative efficacy of these appli- 
cations. With this view the following experi- 
ments were instituted, which, though not so 
numerous and complete as could have been 
wished, will not, it is hoped, be thought alto- 
gether inapplicable to the object for which they 
were attempted. 

EXPERIMENT I. 

The two ears of a full grown rabbit were 
immersed in water, heated near to the boiling 
point. Particular care was taken to immerse 
both ears at the same instant, to plunge them 



/ 



INJURIES BY FIRE. 153 

to the same depth, and to withdraw them to- 
gether. In this way two scalds were obtained, 
as nearly . as possible, equal ; since they were 
inflicted by the same substance at an uniform 
temperature, applied for an equal extent and 
length of time to parts corresponding to each 
other, equidistant from the centre of circulation, 
and both appertaining to the same subject 
"^he animal was now suspended on his back, 
^th his right ear immersed in a vessel of warm 
^ater, at about 100** of Fahrenheit ; the left in 
a Vessel of cold water, having its temperature 
reduced by ice. In this way they continued 
^or three quarters of an hour, the temperature 
°^ both vessels being kept as regular as possi- 
^^® by the occasional addition of warm water 
^nd of ice. The two ears were then wiped dry 
^'^d covered with common resinous ointment 

2d day. — The right ear, to which warm 
^ter had been applied, was red and opaque, 
^^ the skin remained sound ; the left was evi- 
^^tly more inflamed, and contained several 
^Ml vesications and excoriations. The heat of 
^tli was somewhat above the natural standard. 

3d day. — The cuticle had separated from 



154 TREATMENT OP 

both ears to some extent, but most from fcJ*^ 
left, to which the cold application had be^^ 
made. A small slough likewise separated fr9<^^ 
this ear. 

4th day. — Additional portions had separat^^ 
from both ears, but most from the left. 

From the fifth to the eighteenth day bofc* 
ears continued in a state of ulceration. Ttai^^ 
tip of the ears having been the first part inc^* 
>mersed, and the last withdrawn, was of coui»^ 
the most intensely scalded, and sloughed Oi^V 
from both to some extent. The left ear, whic.!^* 
had undergone the cold treatment, suffered inoe^i^ 
by gangrene, and was several days later tha^ciSi 
the other in healing. 

EXPERIMENT II. 

The two ears of a rabbit were immersed i ^ 

scalding water as formerly. The right ear w^^*« 
covered as far it was scalded with the stimula— ^*" 
ing ointment of Mr. Kentish, made of basilico' 
thinned to the consistence of a liniment wi^ 
oil of turpentine. To the left ear was appli^^ 
a saponaceous liniment, composed of eqt^"^^ 
parts of lime water and olive oil. 



INJURIES BT FIRE. 155 

Three hours afterward the ears were exam- 
Wed. The heat of both was much increased 
'^^t that of the right, to which the spirit of tur- 
pentine had been applied, was evidently great- 
est The pain of this ear was likewise evinced 
^y the animal lopping it or laying it on its 
l>a.ck, while the other was carried upright. 
Some small blisters had risen on this ear, but 
'^one were observed on the other. 

2d day. — Both ears were preternaturally 
^arm and red, the right continuing more so. 
They were now covered with resinous oint- 
ftient 

3d day. — A part of the tip of the right ear 
^^parated, and some of the remainder appeared 
^^stitute of sensation. The left was red and 
^flamed, but with no appearance of mortifica- 
tion. 

4th and 5th days. — More of the right ear 
^ame off. The left was ulcerated, but without 
^Qy appearance of gangrene. 

6th — 8th days. — The ulceration continued 
'^thout any slough from the left ear- About 
^lie 9th day, the weather, which had been tern- 
Pirate, became cool ; and the ears, which were 



156 TREATMENT OF 

kept moist by the ointment and their own dis- 
charge, became constantly cold. To this cir- 
cumstance I attributed the formation of a con- 
siderable slough, which came from the right ear 
about the tenth, and from the left on the four- 
teenth day. Both ears soon after healed. 

EXPERIMENT III. 

The ears of a rabbit being equally scalded as 
before, the right was covered with Mr. Kentish's 
ointment, while the left was immersed in cold 
water with ice for three quarters of an hour. 
The left was then covered with basilicon, which 
ointment on the second day was applied to 
both. 

2d day. — The right ear was blistered, and 
discharged a considerable quantity of serum or 
pus. The left was in a similar situation, but in 
a less degree. 

3d day. — Both ears were in a state of sup- 
puration, but the right much the worst; the 
discharge from this ear being general, from the 
other partial. 

The right ear continued, to appear the worst 
during the recovery, which was not complete 



INJUBIES BT FIRE. lOT 

before the 30th day. The loss of substance by 
sloughing was not great from either ear, but 
was least from the left 

EXFERIMENT lY. 

A fourth rabbit was dipped in the same 
manner with the others; afterwards one ear 
was immersed in water, the other in proof 
spirit at the temperature of the room. The 
scalds, however, proved to be slight, as nothing 
ensued but a trifling redness and opacity in the 
parts immersed, which disappeared in two or 
three days, and nearly at the same time from 
both. This experiment would not have been 
mentioned, did it not serve to show the ground 
for fallacy, which arises from comparing the cases 
of different individuals. Had the result of this 
case been contrasted with any of the former, on 
presumption that the injuries received were 
equal, a very erroneous deduction might have 
been the consequence. 

The foregoing experiments were conducted 
on a plan, which, I conceive, were it pursued to 
a considerable extent, would approach as near 



s 



158 Tit:ATMENT OF 

to demonstrative certainty, as any aubject k ^ 

conjectural science of medicine is capable of '^ 

arriving. A desire of the truth, however, oblige ^ 

me to state the diflSculties which remain, and -t 

which may seem to detract something from the 
weight of the experiments. The ear, which • 
was the part subjected to experiment, is com- 
posed chiefly of cartilage and skin ; it is remote 
from the centre of circulation, and its powe«» of 
life comparatively feeble. Possibly a dififerent 
mode of treatment may suit this part, from tiiat 
which agrees with muscles and cellular sub- 
stance. This is not to be considered as very 
probable, since the living animal fibre is apt to 
exhibit similar phenomena in any part of the 
body under the influence of the same disease. 
If any peculiarity existed in the ear, it was 
probably that of being less susceptible of the 
action of stimuli. A trial would have been 
made with some more central part, had tiie 
operation been equally convenient. A second 
imperfection in these experiments was caused 
by the accession of cold weather, which appar- 
ently occasioned a more extensive gangrene, 
than would have ensued under the use of the 



INJURIB8 BY FIRE. 159 

^^emedies, without this circumstance. It did 
.sot, however, occur during the first days, so 
^that the following appearances may be consid- 
ered as free from fallacy. 

1st. The evident increase of heat, pain, red- 
:^ess, vesication, and gangrene, following the 
^ipplication of oil of turpentine. Exp. ii. and 

2d. The increase of most of the same appear- 
^tnces, where cold water was used in contrast 
"^with warm. Exp. i. 

As comparative cases come within the plan 
^jf these remarks, the following case, in which 
different remedies were applied to the same 
subject, is extracted from the Medical and Fhys- 
M.cal Journal, vol. 18, page 209. 

* Samuel James, aged forty, had his face, 
liands and back most severely burnt by the 
explosion of hydrogen gas in a coal mine. 
TThe cold application was used to the face and 
^ands ; the warm oil of turpentine, according to 
^IVIr. Kentish's plan, (originally recommended by 
Keister,) was applied to the back, and dressed 
afterward with unguent, resinee flav. softened 
down with the same: in order to try which 



160 TREATMENT OF 

mode of treatment afforded the most immediate 
ease to the patient, as well as the most expedi- 
tious cure. According to the patient's own 
account, the pain of the hands and face was 
immediately relieved by the cold application, 
but he complained of the oil of turpentine oc- 
casioning a smarting sensation on the back for 
five or six hours. This mode of dressing was 
continued for the space of two days ; but ob- 
serving a considerable degree of inflammation 
remaining from the terebinthinate application, 
that dressing was changed for the neutralized 
cerate, which the patient did not observe, his 
eyes being closed by the great tumefaction of 
the face ; but he expressed the utmost satisfac- 
tion from the superior comfort he felt in that 
dressing compared with the former. The next 
day the back appeared much less inflamed, con- 
tinued gradually getting better, and was cured 
in three weeks. "I am confident," says Dr. 
Evans, the relater of the case, " the back would 
have gotten well sooner under the cooling plan 
of treatment; for the patient constantly com- 
plained of the great heat in the part during 
the application of the oil of turpentine."' 



INJURIES BY FIRE. 161 

In a variety of cases which have occurred 
under my own observation, it has not been 
practicable to contrast the effects of different 
dressings; so that little of a decisive nature 
can be gathered from them. In one case, how- 
ever, which I witnessed, of a very severe and 
extensive burn in a child aged ten years, which 
was occasioned by the clothes taking fire, and 
which afterward terminated fatally; the appli- 
cation of the oil of turpentine in the form of a 
liniment produced the most violent aggravation 
of pain, which did not cease before the patient 
was thrown into convulsions. Instances of the 
same effect have been mentioned to me by 
several medical friends. 

Most writers, who appear as principal advo- 
cates of any mode of practice, feel obliged to 
produce something like a theory or rationale, 
which shall account for, or at least apply to the 
facts and phenomena adduced. Accordingly, 
Mr. Kentish and the others have not omitted 
to back their catalogue of cases with a train of 
reasoning illustrative of the propriety of their 
special applications. Of these the two princi- 
pal are entitled to a separate attention, 
11 



162 TREATMENT OP 

OF THE STIMULANT FLAN. 

In defence of the oil of turpentine and other 
stimulant applications, Mr. Kentish states the 
following as a law of the system. * That any 
part of the system having its action increased 
to a very high degree, must continue to be ex- 
dited, though in a less degree, either by the 
stimulus which caused the increased action, or 
some other having the nearest similarity to 
it; until, by degrees, the extraordinary action 
subsides into the healthy action of the part' 
It ha« also been urged by supporters of the 
plaii, that a lesser stimulus, as the oil of tur- 
pentine, is comparatively sedative in its opera- 
tion on a part violently excited by a burn. The 
above reasoning may amuse the imagination, 
but does not satisfy the judgment. The anal- 
ogy of almost every subject in medicine and 
surgery teaches us, that a part already highly 
irritated receives no benefit from an additional 
stimulus, which must tend only to increase the 
sum of the irritation. If a man bruise his 
finger, do we, by way of expediting the cure, 
proceed to bruise it again, but with less vio- 
lence, because < it must continue to be excited 



INJURIES BT FIRE. 163 

^^ ^ less degree,' * until the extraordinary action 

w«>si^es into the healthy action of the part ? ' 

^ if a man has received an hundred lashes, 

snail a surgeon prescribe ninety more, because 

'^ety lashes are less stimulating than an hun- 

^f^d, and therefore comparatively sedative? 

The propriety is just the same, when we irritate 

^th acrid spirit of turpentine a part already 

snflfering violent pain and inflammation, as well 

^ increased sensibility, from a bum. Though 

^^^ spirit of turpentine applied to a healthy 

8urftt<;e is less injurious than fire, yet if we 

apply the one to a part already injured by the 

oth^j.^ we only inflict a double evil, or produce 

a^ Aggregate of the mischief of both. 

"N^ith regard to the internal stimulant plan 
of Air. Kentish, it is advocated on a ground 
^^^ less exceptionable. He assumes it as a 
tact, that *a healthy, vigorous man' suffers less 
y ^ burn of the same extent, than * a man of 
^^ imtable habit;' and from thence he infers 
^^^t strength resists the ill consequences of 
these injuries, while weakness promotes them ; 
^^d that therefore, in all cases, <we should 
^^ke the system as strong as we can immedi- 



164 TREATMENT OF 

ately on the attack.' Whether this principle 
be just may very properly be questioned, since 
it is an admitted fact, that from ordinary 
mechanical injuries, a vigorous, plethoric man 
suiTers a higher degree of inflammation, than 
one whose strength and quantity of blood are 
less, and whose powers of reaction of course 
are more feeble. When a common injury takes 
place, which is capable of producing inflamma- 
tion and symptomatic fever, depletion and the 
antiphlogistic regimen are resorted to as pre- 
ventives y and this in a greater or less degree, 
according as the subject is more or less ple- 
thoric. For instance, if a vigorous men receive 
a contusion on any part of his body, so violent 
as to endanger suppuration or gangrene, we 
prevent or mitigate these symptoms by blood- 
letting, purging, and abstinence. Now if the 
same man had received a burn on the same 
part, endangering the same symptoms, ought 
our practice to be different ? Is the system so 
revolutionized as to require opposite treatmenti 
because an injury is caused by fire instead of 
mechaniced violence ? Or is a stout and pletho- 
ric patient, with a full, hard, and firequent pulse, 



INJURIES BT FIRE. 165 

*Q be stimulated with brandy and laudanum, 
'because his fever originated in a bum ? It is 
certainly the height of empiricism to prescribe a 
specific mode of treatment for a disease, merely 
from its name. A rational treatment is always 
dependent on circumstances, and is stimulant 
^^i" sedative, according to the constitution of the 
patient, the state of the pulse, and the condition 
^f the system. 

OF THE COOLING FLAN. 

8ir James Earle, and Dr. Kinglake, the former 
^ his Essay, and the latter in the Medical and 
Physical Journal, have advocated a mode of 
^atment precisely opposite to that of Mr. Ken- 
tish ; yet, like him, they seem to have erred in 
ptirsuing a favorite remedy to extremes. The 
general and continued application of cold to a 
part injured by a burn or scald, is resorted to, 
feom a belief of its tendency to abstract the 
excess of caloric from the part, and to restore 
the equilibrium. This belief is a just one, so 
far as it applies to the application of cold for a 
short time, immediately after the injury from a 
heated substance is received ; but the continued 



166 TREATMENT OP 

application of it for hours and days on the same 
principle, is altogether unphilosophical, and has 
been sufficiently refuted in the treatise of Mr. 
Kentish. Every particle of caloric communi- 
cated to the living body by a hot substance, 
may be abstracted in one minute by plunging 
the part affected in cold water ; and if this im- 
mersion be continued, the temperature will soon 
be reduced below the natural standard. It is 
true that on withdrawing the affected part, its 
temperature will soon rise to the former pitch ; 
but this increased temperature can be nothing 
more than animal heat, a little increased by the 
violent action of the part, as happens in most 
cases of inflammation. As to the common 
phrase of 'killing the fire,' by which is meant 
only the relief of pain that takes place at the 
commencement of resolution or suppuration ; 
this cannot be hastened by cold applications, 
except in slight cases which admit of resolu- 
tion ; whereas, in cases where blisters have 
arisen, and suppuration is about to take place, 
its progress is only retarded by the employment 
of cold. 

With regard to the antiphlogistic regimen, 



INJURIES BY FIRE. 167 

nothing more need be said, than that its use or 
omission must be determined altogether by the 
state of the system. 

It may be proper in this place to say some- 
thing respecting the use of alcohol, ether, and 
proof spirit These substances are often re- 
commended in a vague manner, without refer- 
ence to the mode of their application, although 
on this circumstance depends their efficacy. If 
a part of the body be washed with cold spirit, 
or a thin cloth wet with spirit be applied, the 
rapid evaporation which takes place, renders 
the effect powerfully refrigerant. On the con- 
trary, if the part be immersed in spirit, or the 
spirit be applied warm, or with a thickly folded 
cloth, its operation is unquestionably that of a 
stimulant 

After considering at length the opposite ex- 
tremes of treatment which have been adopted, 
the result of both reason and experiment ap- 
pears to be, that the two extremes are alike 
injudicious when pursued in their full extent, 
and neither of them suited to ihe varieties of 
burns and of constitutions. An intermediate 
plan of treatment, which shall vary according 



168 TREATMENT OF 

to circumstances, and be dependent on the de- 
gree and state of disease, is undoubtedly the 
most deserving of attention. 

In slight burns where no vesications take 
place, and where resolution appears practicable, 
we should resort to cooling applications, either 
water or of spirit ; since in this way the most 
speedy relief is generally given to the pain, and 
likewise, as in other inflammations, resolution 
is accelerated. The preparations of lead, or any 
other discutient, may be added when thought 
proper. In all cases of bums and scalds it may 
be expedient to make one application of cold 
water as soon as possible after the injury, to 
abstract the heat from the clothes, skin, &c., 
and prevent the spreading of its effects. 

In more violent burns, attended with blisters 
and acute pain, a permanent relief is to be ex- 
pected only from suppuration. This is pro- 
moted, as in other cases of suppurative inflam- 
mation, not by acrid stimulants, not by snow 
and ice ; but by mild emollients and warm fo- 
mentations or poultices. Though cold applica- 
tions, by benumbing the nerves, may afford a 
temporary relief of pain, yet this returns with 



INJURIES BT FIRE. 169 

^qual or increased violence when these applica- 
tions are discontinued ; so that they must be 
persevered in for a long time, until tardy sup- 
puration appears in spite of them, before effec- 
teal relief is given. In the first experiment on 
*he rabbits, the ear which was immersed in cold 
^ater fared worse than its fellow, which was 
"Vped in warm. In the treatment of burns 
Gilding to suppuration, perhaps no application 
^s better than a liniment of lime water and oil. 
*his is very gently soothing and astringent, 
^fld by its saponaceous quality unites with the 
^scharge, and is thus more generally and 
^SLUally applied than any unctuous substance 
^<>uld be in its place. 

In very violent burns, where the life of a part 
^^ destroyed, or where the inflammation is so 
S^^^at as to render mortification to a considera- 
^*^ extent probable, our treatment must depend 
^^ the state of the system and the appearance 
^^ the part. If marks of active inflammation 
^^^ present, with increased heat and force of 
Circulation, a sedative and depleting plan is to 
^e followed, until the violent action has abated. 
^^ the contrary, if the inflammation be of the 



170 INJURIES BY FIRE. 

passive kind, with diminished action of the 
part, and atony and prostration of strength in 
the system, we may then depend on stimulants 
and antiseptics. It can be only in burns of this 
kind that Mr. Kentish's method of treatment 
is admissible in any extent 

In the subsequent treatment of burns, if ex- 
uberant granulations arise, they may be re- 
pressed by gentle astringents, by pressure, or by 
escharotics. Mr. Kentish recommends powder- 
ed chalk, but this I have found insufficient 
when mixed with a third part of burnt alum. 
Pure alum answers the purpose perfectly well 
The separation of sloughs is facilitated, ac- 
cording to Mr. Kentish, by introducing pow- 
dered chalk into the cavities between them and 
the living parts. 

The contraction of the cicatrix is often an 
unpleasant consequence of burns. It may be 
obviated in a degree by a proper position of 
the cicatrizing part. Sometimes the contrac- 
tion is so great as to impede circulation ; in 
which case it is necessary to divide the newly 
formed skin in different places, thus allowing it 
room to expand. 



ON THE 



BURIAL OF THE DEAD. 



^e interest which the author has felt in the Cemetery at 
^OTut Aubam, the first of its kind in the United States, has in 
^ iiieasare grown out of his personal connection with its foun- 
^tion and subsequent development The project of Mount 
-^ubam was originally conceived^ the preparatory meetings 
®^lled, the land selected and engaged, and the larger public 
tinctures, the gate chapel tower a]|4 iron fence designed, 
^y himself at different times.* The pleasure of witnessing, 
*Wough so many years, the progressive improvement of this 
*^^utiful spot, has been enhanced by the interest and active 
^^OM)peration of many of our distinguished and valued citizens. 

Vhile the subject was of recent agitation, the following Ad- 
^fQss was delivered at the hall of the Masonic Temple, before 
**^© Boston Society for the Promotion of Useful Knowledge. 

The manner in which we dispose of the 
J'emains of our deceased friends, is a subject 
^hich, within the last few years, has occupied 

* Historical notices of Mount Auburn have been published 
"y Thacher, Walter, Dearborn, and others, also in the Daily 
A'dveriiser, Sept. 9, 1861, and the Boston Atlas, Sept. 16, 1851. 



172 ON THE BURIAL 

a greater share than formerly of the public at- 
tention in our own vicinity. It involves not 
only considerations which belong to the gene- 
ral convenience, but includes also the gratifica- 
tion of individual taste, and the consolation of 
private sorrow. Although, in a strictly philo- 
sophical view, this subject possesses but little 
importance, except in relation to the conveni- 
ence of survivors ; yet so closely are our sym- 
pathies enlisted with it, so inseparably do we 
connect the feelings of the living with the con- 
dition of the dead, that it is in vain that we 
attempt to divest ourselves of its influence. It 
is incumbent on us therefore to analyze, as far 
as we may be able, the principles which belong 
to a correct view of this subject; since it is 
only by understanding these, that we may ex- 
pect both reason and feeling to be satisfied. 

The progress of all organized beings is to- 
wards decay. The complicated textures which 
the living body elaborates within itself, begin 
to fall asunder almost as soon as life has 
ceased. The materials of which animals and 
vegetables are composed, have natural laws and 
irresistible affinities which are suspended during 



OF THE DEAD. 



173 



period of life, but which muat be obeyed 
the moment that life is extinct These con- 
tinue to operatCj until the exquisite fabric is 
reduced to a condition, in no wise different 
from that of the soil on which it has once 
trodden. In certain cases art may modify, and 
accident may retard, the approaches of disor- 
ganization, but the exceptions thus produced 
are too few and imperfect, to invalidate the 
certainty of the general law. 

If we take a comprehensive survey of the 
progress and mutations of animal and vegetable 
life, we shall perceive that this neeesaity of 
individual destruction is, the basis of general 
safety. The elements which have once moved 
and circulated in living frames do not become 
extinct nor useless after death ; they offer them- 
selves as the materials from which other living 
irames are to *be constructed. What has once 
■assessed life is most assimilated to the living 
character, and most ready to partake of life 
again* The plant which springs from the earth, 
fter attaining its growth and pcrpctuatitig its 
secies, falls to the ground, undergoes decompo- 
ion, and contributes its remains to the Hour- 



174 ON THE BURIAL 

ishment of plants around it The myriads of 
animals which range the woods, or inhabit the 
air, at length die upon the surface of the earth, 
and, if not devoured by other animals, prepare 
for vegetation the place which receives their 
remains. Were it not for this law of nature, 
the soil would be soon exhausted, the earth's 
surface would become a barren waste, and the 
whole race of organized beings, for want of 
sustenance, would become extinct. 

Man alone, the master of the creation, does 
not willingly stoop to become a participator in 
the routine of nature. In every age he has 
manifested a disposition to exempt himself, and 
to rescue his fellow, from the common fate of 
living beings. Although he is prodigal of the 
lives of other classes, and sometimes sacrifices 
a hundred inferior bodies, to procure himself a 
single repast, yet he regards with scrupulous 
anxiety the destination of his own remains; 
and much labor and treasure are devoted by 
him to ward off for a season the inevitable 
courses of nature. Under the apprehension of 
posthumous degradation, human bodies have 
been embalmed, their concentrated dust has 



OF THE DEAD. 175 

been inclosed in golden urns, monumental for- 
tresses have been piled over their decaying 
bones ; with what success, and with what use, 
it may not be amiss to consider. 

I have selected a few instances, in which 
measuries have been taken to protect the human 
frame from decay, which will be seen to have 
been in some cases partially successful, in 
others not so. They will serve as preliminaries 
to the general considerations which are con- 
nected with the subject. 

One of the most interesting accounts of the 
preservation of a body, the identity of which 
was undoubted, is that of the disinterment of 
King Edward I. of England. The readers of 
English history will recollect that this monarch 
gave, as a dying charge to his son, that his 
heart should be sent to the Holy Land, but 
that his body should be carried in the van of 
the army till Scotland was reduced to obedi- 
ence. 

He died in July, 1307, and notwithstanding 
his injunctions, was buried in Westminster 
Abbey in October of the same year. It is re- 
corded that he was embalmed, and orders for 



176 ON THE BURIAL 

renewing the cerecloth abont his body were 
issued in the reigns of Edward III. and Henry 
IV. The tomb of thb monarch was opened, 
and his body examined in January, 1774, under 
the direction of Sir Joseph Ayloffe, after it had 
been buried four hundred and sixty-seven years. 
The following account is extracted from a con- 
temporaneous volume of the GrenUeman's Mag- 
azine. 

* Some gentlemen of the Society of Antiqua- 
ries, being desirous to see how far the actual 
state of Edward First's body answered to the 
methods taken to preserve it, obtained leave to 
open the large stone sarcophagus, in which it is 
known to have been deposited, on the north 
side of Edward the Confessor's chapel. This 
was accordingly done on the morning of Janu- 
ary 2, 1774, when in a coffin of yellow stone 
they found the royal body in perfect preserva- 
tion, inclosed in two wrappers; one of them 
was of gold tissue, strongly waxed, and fresh, 
the other and outermost considerably decayed. 
The corpse was habited in a rich mantle of 
purple, paned with white, and adorned with 



OF THE DEAD. 177 

ornaments of gilt metal, studded with red and 
blue stones and pearls. Two similar ornaments 
lay on the hands. The mantle was fastened on 
the right shoulder by a magniiScent fibula of 
the same metal, with the same stones and 
pearb. His face had over it a silken covering, 
so fine^ and so closely fitted to it, as to preserve 
the features entire. Round his temples was a 
gilt coronet of fleurs de lys. In his hands, 
which were also entire, were two sceptres of 
gilt metal ; that in the right surmounted by a 
cross fleure, that in the left by three clusters of 
oak leaves, and a dove on a globe ; this sceptre 
was about five feet long. The feet were envel- 
oped in the mantle and other coverings, but 
sound, and the toes distinct. The whole length 
of the corpse was five feet two inches.' 

This last statement, it will be observed, is 
the only point in which the narrative appears 
to disagree with history. We are generally 
given to understand that Edward I. was a tall 
man ; and that he was designated in his own 
lime by the name of Long-shanks. Baker, in 
his Chronicle of the Kings of England, says of 
13 



178 ON THE BURIAL 

him that he was tall of stature, exceeding most 
other men by a head and shoulders. I have not 
been able to find Sir Joseph Aylofle's account 
of the examination, and know of no other mode 
of reconciling the discrepancy, but by supposing 
a typographical error of a figure in the account 
which has been quoted. 

Edward I. died at Burgh-upon-Sands, in 
Cumberland, on his way to Scotland, July 7, 
1307, in the sixty-eighth year of his age. 

Another instance of partial preservation,, is 
that of the body of King Charles L, who was 
beheaded by his subjects in 1649. The re- 
mains of this unfortunate monarch kre known 
to have been carried to Windsor, and there 
interred by his friends without pomp, in a hasty 
and private manner. It is stated in Claren- 
don's History of the Rebellion, that when his 
son, Charles II., was desirous to remove and 
re-inter his corpse at Westminster Abbey, it 
could not by any search be found. In con- 
structing a mausoleum at Windsor in 1813^ 
under the direction of George IV, then Prince 
Regent, an accident led to the discovery of this 
royal body. The workmen, in forming n sub- 




THE DEI 



terraneous passage under the choir of St. 
George's Chapel, accidentally made an aper- 
ture in the wall of the vault of Kiog Henry 
VIIL On looking through this opening it was 
found to contain three coffins, instead of two, 
as had been supposed. Two of these were 
' ascertained to be the coffins of Henry VHL 
and of one of his queens, Jane Seymour. The 
other was formaJly examined, after permission 
obtained, by Sir Henry Halford, in presence of 
several members of the royal family, and other 
persons of distinctioa. The account since pub- 
lished by Sir Henry, corroborates the one which 
1 had been ^iven by Mr. Herbert, a groom of 

!King Charles's bedchamber, and is published 
in Wood's AthensB Oxonienses. 
: 
cli 



* On removing the pall,* says the account, 
•a plain leaden coffin presented itself to view, 
J with no appearance of ever having been in- 
closed in wood, and bearing an inscription, 
"King Charles, 1648," in large, legible charac- 
ters, on a scroll of lead encircling it A square 
■ ig was then made in the upper part of 
I, of such dimensions as to admit a cleat 



180 ON THE BURIAL 

insight into its contents. These were, an in- 
ternal wooden coffin, very much decayed, and 
the body carefully wrapped np in cere-cloth, 
into the folds of which a quantity of tinctaous 
matter, mixed with resin,, as it seemed, had 
been melted, so as to exclude, as effectually as 
possible, the external air. The coffin was com- 
pletely full, and, from the tenacity of the cere- 
cloth, great difficulty was experienced in de- 
taching it successfully from the parts which it^ 
enveloped. Wherever the unctuous matter had 
insinuated itself, the separation of the cere- 
cloth was easy ; and where it came off, a correct 
impression of the features to which it had been 
applied, was observed. At length the whole 
face was disengaged from its covering. The 
complexion of the skin of it was dark and dis- 
colored. The forehead and temples had lost 
little or nothing of their muscular substance ; 
the cartilage of the nose was gone ; but the left 
eye, in the first moment of exposure, was open 
and full, though it vanished almost immediate^ 
ly ; and the pointed beard, so characteristic of 
the period of the reign of King Charles, was 
perfect. The shape of the face was a long 



OF THE DEAD. 181 

oval ; many of the teeth remained ; and the left 
ear, in conseqaence of the interposition of the 
tinctnoas matter between it and the cere-cloth, 
was found entire. 

* It was difficult, at this moment, to withhold a 
declaration, that, notwithstanding its disfigure- 
ment, the countenance did bear a strong resem- 
blance to the coins, the busts, and especially to 
the picture of King Charles the First, by Van- 
dyke, by which it had been made familiar to us. 
It is true, that the minds of the spectators of this 
interesting sight were well prepared to receive 
this impression ; but it is also certain that such 
a facility of belief had been occasioned by the 
simplicity and truth of Mr. Herbert's Narrative, 
every part of which had been confirmed by the 
investigation, so far as it had advanced; and 
it will not be denied that the shape of the 
face, the forehead, the eye, and the beard, are 
the most important features by which resem- 
blance is determined. 

*When the head had been entirely disen- 
gaged from the attachments which confined it, 
it was found to be loose, and without any diffi- 
culty was taken out and held up to view. The 



182 ON THE BURIAL 

back part of the scalp was entirely perfect, and 
had a remarkably fresh appearance ; the pores 
of the skin being more distinct, and the tendons 
and ligaments of the neck were of considerable 
substance and firmness. The hair was thick at 
the back part of the head, and in appearance 
nearly black. A portion of it, which has since 
been cleaned and dried, is of a beautiful dark 
brown color. That of the beard was a redder 
brown. On the back part of the head it was 
not more than an inch in length, and had prob- 
I ably been cut so short for the convenience of 
\ the executioner, or perhaps by the piety of 
friends soon after death, in order to furnish 
memorials of the unhappy king. 

' On holding up the head, to examine the 
place of separation from the body, the muscles 
of the neck had evidently retracted themselves 
considerably; and the fourth cervical vertebra 
was found to be cut through its substance 
transversely, leaving the surfaces of the divided 
portions perfectly smooth and even, an appear- 
ance which could have been produced oqly by 
a heavy blow, inflicted with a very sharp instru- 
ment, and which furnished the last proof want- 
ing to identify King Charles the First.' 



OF THE DEAD; . 183 

The foregoing are two of the most successful 
instances of posthumous preservation. The 
care taken in regard to some other distinguish- 
ed personages has been less fortunate in its 
result. The coffin of Henry VIII. was in- 
spected at the same time with that of Charles, 
and was found to contain nothing but the 
mere skeleton of that king. Bome portions of 
beard remained on the chin, but there was no- 
thing to discriminate the personage contained 
in it. 

During the present century, the sarcophagus 
of King John has also been examined. It con- 
tained little else than a disorganized mass of 
earth. The principal substances found, were 
some half decayed bones, a few vestiges of 
cloth and leather, and a long rusty piece of 
iron, apparently the remains of the sword-blade 
of that monarch. 

The rapidity with which decomposition takes 
place in organic bodies, depends upon the par- 
ticular circumstances under which they are 
placed. A certain temperature, and a certain 
degree of moisture, are indispensable agents in 
the common process of putrefaction, and could 



184 ON THE BURIAL 

these be avoided in the habitable parts of oar 
globe, human bodies might last indefinitely. 
I shall be excused for dwelling a short time 
on the influence of some of these preservative 
agents. Where a certain degree of cold exists, 
it tends powerfully to check the process of 
destructive fermentation, and when it extends 
so far as to produce congelation, its protecting 
power is complete. Bodies of men and ani- 
mals are found in situations where they have 
remained frozen for years, and even for ages. 
Not many years ago, the bodies of some Span- 
ish soldiers were found in a state of perfect 
preservation among the snows of the Andes, 
where they were supposed to have perished in 
attempting to cross those mountains, nearly a 
century ago ; their costume and some historical 
records indicating the probable period of their 
expedition. At the Hospice of the Grand St. 
Bernard in the Alps, some receptacles of the 
dead are shown to travellers, in which, owing to 
the effect of perpetual frost, together with the 
lightness of the atmosphere, but little absolute 
decay has taken place in the subjects deposited 
during a lapse of years. But the most remark- 



OF THE DBAD. 185 

able instance of preservation by frost of an 
animal body, is that of an elephant of an 
extinct species, discovered in 1806 in the ice of. 
the polar sea, near the mouth of the river Lena, 
by Mr. Michael Adams. This animal was first 
seen by a chief of the Tonguse tribe, in the 
year 1799, at which time it was imbedded in a 
rock of ice about one hundred and eighty feet 
high, and had only two feet, with a small part 
of the body, projecting from the side, so as to 
be visible. At the close of the next summer, 
the entire flank of the animal* had been thawed 
out It nevertheless required five summers, in 
this inclement region, to thaw the ice, so that 
the whole body could be liberated. At length, 
in 1804, the enormous mass separated from the 
mountain of ice, and fell over upon its side, 
on a sand bank. At this time it appears to 
have been in a state of perfect preservation, 
^th its skin and flesh as entire as when it had 
existed antecedently to the deluge, or to what- 
ever convulsion of the globe may have trans- 
ported animals apparently of the torrid zone to 
the confines of the Arctic circle. The Tonguse 
chief cut off the tusks, which were nine feet 



186 ON THE BURIAL 

long, and weighed two hundred pounds each. 
Two years after this event, Mr. Adams, being 
, at Yakutsk, and hearing of this event, under- 
took a journey to the spot He found the 
animal in the same place, but exceedingly 
mutilated by the dogs and wolves of the neigh- 
borhood, which had fed upon its flesh as fast 
as it thawed. He however succeeded in re- 
moving the whole skeleton, and in recovering 
two of the feet, one of the ears, one of the 
eyes, and about three quarters of the skin, 
which was covered with reddish hair and black 
bristles. These are now in the museum at St. 
Petersburg. 

The foregoing facts are sufficient to show 
that a low degree of temperature is an effectual 
preventive of animal decomposition. On the 
other hand, a certain degree of heat combined 
with a dry atmosphere, although a less perfect 
protection, is sufficient to check the destructive 
process. Warmth, combined with moisture, 
tends greatly to promote decomposition ; yet if 
the degree of heat, or the circumstances under 
which it acts, are such as to produce a perfect 
dissipation of moisture, the further progress of 



OF THE DEAD. 187 

decay is arrested. In the arid caverns of Egypt 
the dried flesh of mummies, although greatly 
changed from its original appearance, has made 
no progress towards ultimate decomposition, 
daring two or three thousand years. It is 
known that the ancient Egyptians embalmed 
the dead bodies of their friends, by extracting 
the large viscera from the cavities of the head, 
chest and abdomen, and filling them with aro- 
matic and resinous substances, particularly as- 
phaltum, and enveloping the outside of the 
body in cloths impregnated with similar mate- 
rials. These impregnations prevented decompo- 
sition for a time, until perfect dryness had taken 
place. Their subsequent preservation, through 
so many centuries, appears to have been owing, 
not so much to the antiseptic quality of the 
substance in which they are enveloped, as to 
the effectual exclusion of moisture. 

In the crypt under the cathedral of Milan, 
travellers are shown the ghastly relics of Carlo 
Borromeo, as they have lain for two centuries, 
inclosed in a crystal sarcophagus, and bedecked 
with costly finery, of silk and gold. The pre- 
servation of this body is equal to that of an 



189 ON THE BURIAL 

Egyptian mummy, yet a more loathsome piece 
of mockery than it exhibits, can be hardly 
imagined. 

It will be perceived that the instances which -* 

have been detailed are cases of extraordinary ^ 

exemption, resulting from uncommon care, or ^ 

from the most favorable combination of cir- *** 

cumstances, such as can befall but an exceed- "^ 

ingly small portion of the human race. The ^ 

common fate of animal bodies is to undergo ^ 

the entire destruction of their fabric, and the * 

obliteration of their living features in a few 
years, and sometimes even weeks, after their 
death. No sooner does life cease, than the ^ 

elements which constituted the vital body be- 
come subject to the common laws of inert 
matter. The original affinities, which had been 
modified or suspended during life, are brought 
into operation, the elementary atoms react upon 
each other, the organized structure passes into 
decay, and is converted to its original dust. 
Such is the natural, and, I may add, the proper 
destination of the material part of all that has 
once moved and breathed. , 

The reflections which naturally suggest them- f 



OF THE DEAD. 189 

selves in contemplating the wrecks of humanity, 
'^rhich have occasionally been brought to light, 
are such as lead us to ask, of what possible 
tase is a resistance to the laws of nature, which, 
'^vhen most successfully executed, can at best 
only preserve a defaced and degrading image 
of -what was once perfect and beautiful ? Could 
"we, by any means, arrest the progress of decay, 
80 as to gather round us the dead of a hundred 
generations in a visible and tangible shape; 
oonid we fill our houses and our streets with 
nnmmies, — what possible acquisition could 
te more useless, what custom could be more 
revolting ? — For precisely the same reason the 
subterranean vaults and the walls of brick, 
'which we construct to divide the clay of hu- 
manity from that of the rest of creation, and to 
preserve it separate for a time, as it were for 
future inspection, are neither useful, gratifying, 
nor ultimately effectual. Could the individuals 
themselves, who are to be the subjects of this 
csare, have the power to regulate the officious 
zeal of their survivors, one of the Ust things 
they could reasonably desire would be, that the 
light should ever shine on their changed and 
crumbling relics. 



190 ON TBE BURIAL 

On the other hand, when nature is permitted 
to take its course, when the dead are committed 
to the earth under the open sky, to become 
early and peacefully blended with their original 
dust, no unpleasant association remains. It 
would seem as if the forbidding and repulsive 
conditions which attend on decay, were merged 
and lost in the surrounding harmonies of the 
creation. 

When the body of Major Andre was taken 
up, a few years since, from the place of its in- 
terment near the Hudson, for the purpose of 
being removed to England, it was found that 
the skull of that officer was closely encircled by 
a network, formed by the roots of a small tree, 
which had been planted near his head. This 
is a natural and most beautiful coincidence. 
It would seem as if a faithful sentinel had 
taken his post, to watch, till the obliterated 
ashes should no longer need a friend. Could 
• we associate with inanimate clay any of the 
feelings of sentient beings, who would not wish 
to rescue his remains from the prisons of man- 
Kind, and commit them thus to the embrace of 
nature ? 



OF THE DEAD. 191 

Convenience, health and decency require that 
the dead should be early removed from our 
sight. The law of nature requires that they 
should moulder into dust, and the sooner this 
change is accomplished, the better. This change 
should take place, not in the immediate conti- 
guity of survivors, not in frequented receptacles 
provided for the promiscuous concentration of 
numbers, not where the intruding light may 
annually usher in a new tenant, to encroach 
upon the old. It should take place peacefully, 
silently, separately, in the retired valley, or the 
sequestered wood, where the soil continues its 
primitive exuberance, and where the earth has 
not become too costly to afford to each occu- 
pant at least his length and breadth. 

Within the bounds of populous and growing 
cities, interments cannot with propriety take 
place beyond a limited extent. The vacant 
tracts reserved for burial grounds, and the 
cellars of churches which are converted into 
tombs, become glutted with inhabitants, and 
are in the end obliged to be abandoned, though 
not perhaps until the original tenants have been 
ejected, and the same space has been occupied 



193 ON THE BURIAL 

three or four successive times. Necessity 
obliges a recourse at last to be had to the 
neighboring country, and hence in Paris, Lon- 
don, Liverpool, Leghorn, and other European 
cities, cemeteries have been constructed without 
the confines of their population. These places, 
in consequence of the sufficiency of the ground, 
and the funds which usually grow out of such 
establishments, have been made the recipients 
of tasteful ornament. Travellers are attracted 
by their beauty, and dwell with interest on their 
subsequent recollection. The scenes which, 
under most other circumstances, are repulsive 
and disgusting, are by the joint influence of 
nature and art rendered beautiful, attractive, 
and consoling. 

The situation of Mount Auburn, near Boston, 
is one of great natural fitness for the objects 
to which it has been devoted. Independently^ 
of its superior size, it may be doubted whether 
any spot, which has been set apart for the 
same purposes in Europe, possesses half the 
interest in its original features. In a few years, 
when the hand of taste shall have scattered 
among the trees, as it has already begun to do. 



OF THE DEAD. 193 

enduring memorials of marble and granite, a 
landscape of the most picturesque character 
wil be created. No place in the environs of 
our city will possess stronger attractions to the 
visiter. To the mourner it offers seclusion, 
amid the consoling influences of nature. The 
moralist and man of religion will 

• Find room 
And food for meditation, nor pass by 
Much, that may give him pause, if pondered fittingly.' 

We regard the relics of our deceased friends 
and kindred for what they have been, and not 
for what they are. We cannot keep in our 
presence the degraded image of the original 
frame ; and if some memorial is necessary to 
soothe the unsatisfied want, which we feel 
when bereaved of their presence, it must be 
found in contemplating the place in which we 
know that their dust is hidden. The history 
of mankind, in all ages, shows that the human 
heart clings to the grave of its disappointed 
wishes, that it seeks consolation in rearing 
emblems and monuments, and in collecting 
images of beauty over the disappearing relics 
13 



194 ON THE BURIAL OF THE DEAD. 

of humanity. This can be fitly done, not in 
the tumultuous and harassing din of cities, 
not in the gloomy and almost unapproachable 
vaults of charnel houses ; — but amidst the 
quiet verdure of the field, under the broad and 
cheerful light of heaven, — where the harmo- 
nious and ever changing face of nature reminds 
us, by its resuscitating influences, that to die 
is but to live again. 



REMARKS ON PNEUMOTHORAX : 

WITH CASES, AND AH EXPEaDfBNTAL INQUIBT INTO THE CAUSES 
OF THE METALUC SOUNDS HEABD IN THAT DISEASE. 

[From the American Jonmal of Medical Sciences, 1839.] 

The sounds which are heard during auscul- 
tation in cases of pneumothorax, especially 
when life has been prolonged for a considerable 
time under the disease, have a character, of 
which the term metallic is eminently descrip- 
tive. This character may be recognized not 
only in the respiration and cough, but frequently 
also in the voice and the succussion and percus- 
sion of the chest. The sound is either sharp 
and tinkling, or it is prolonged, reverberating 
and ringing, according to the kind of action 
tinder which it is produced. In both cases the 
mechanical condition of the chest is apparently 
the same. 



196 REMARKS ON PNEUMOTHORAX. 

The sounds of pneumothorax, as will appear 
from the experiments detailed at the end of 
this article, are divisible, with relation to their 
causes, into those of impulse, and those of re- 
verberation. The first requires the presence of 
liquid, the second may take place with only the 
presence of air. The first includes all the varie- 
ties of metallic tinkling which are heard in res- 
piration, which also take place after speaking 
and coughing, and which may be abundantly 
produced in many cases by succussion of the 
chest. When well developed it is sharp, silvery 
and musical, resembling the note of short brass 
wires in certain children's toys. The second 
T^lass, that of reverberating sounds, includes the 
varieties of amphoric breathing, and may be 
imitated by inflating a recent bladder to a con- 
siderable degree of tension while in contact with 
the ear, or less perfectly by blowing into a glass 
or metallic vessel. When a sudden impetus is 
given to it by coughing, this sound becomes 
more intense, ringing and metallic. The voice 
also at times acquires the metallic resonance. 
If percussion be performed on the distended 
chest, while the ear is applied to its parietes, a 



BKMARXS ON PNEUMOTHORAX. 197 

ringing sound is communicated, having more or 
less of a metallic character. 

Metallic tinkling of the chest, although one of 
the most marked of the physical signs, appears 
not to have been fully explained in regard to 
the immediate cause by which it is produced. 
Various hypothetical solutions have at different 
times been offered, but all of them have been 
objected to, or seem liable to objections, on the. 
score of insufficiency ; and no one of them ap- 
pears at this time to have obtained a general 
assent. A brief summary is sufficient to present 
the leading features of the different modes in 
which this phenomenon has been accounted for. 

The only explanation given by Laennec of 
this sound is by him considered applicable to 
cases of what he calls simple hydro-pneumotho- 
rax, in which there is no communication with 
the bronchi® ; a form of the disease, however, 
the existence of which has been doubted by 
some subsequent writers. Laennec says that if 
a patient happen to raise himself suddenly in 
bed, and a drop of fluid fall fron the upper part 
of the cavity of the pleura into the fluid beneath, 
it produces a sound like that occasioned by a 



198 REMARKS ON PNEUMOTHORAX. 

drop of water let fall into a flask three quarters 
empty, and this sound is immediately followed 
by a distinct metallic tinkling. A similar sound 
he says may be heard by ausculting the epigas- 
trium of a person who is swallowing water in 
minute quantities. This explanation has been 
adopted by various subsequent writers, as a 
general mode of accounting for the phenomenon 
of metallic tinkling. 

Dr. C. J. B. Williams, author of valuable 
works on diseases of the lungs and pleura, ex- 
plains metallic tipkling on the principle of 
reverberation or echo, produced in a cavity of 
uniformly reflecting parietes by the communica- 
tion of a sound, or of a soniferous impulse to 
the air contained within it. He considers that 
in common cases of pneumothorax communi- 
cating with a bronchus, if the fistulous opening 
be small, metallic tinkling will be produced, but 
if large, or if several such openings exist, there 
will be only amphoric resonance. 

Dr. Thomas Davies, in his lectures at the 
London Hospital on diseases of the chest, says : 
* The metallic tinkling is caused by the reso- 
nance of air agitated upon the surface of a 



REMARKS OK PNEUMOTHORAX. 199 

liquid contained in a preternatural cavity form- 
ed in the chest' * This explanation may have 
been suggested by a note of M. Meriadec Laen- 
nee in his edition of the great work of his rela- 
tive, who says that the sound in question 
appears to depend upon the vibration of a gas 
upon the surface of a liquid. 

Dr. James Houghton, author of the article 
Pneumothorax in the Cyclopedia of practical 
medicine, adopts the idea of an echo, which he 
derives both from the dropping of fluid in a 
cavity, and from the entrance of air through a 
fistulous opening. The latter variety, he says, 
appears to be manifestly the echo of the air 
forced into the cavity, reverberating against its 
hollow parietes ; and the sound, he thinks, is 
more particularly caused by the bursting of 
minute air bubbles at the orifice of the fistula, 
formed as the air traverses the latter by the en- 
tanglement of mucus. He thinks that the tink- 
ling will be more or less loud and distinct in 
proportion as the fistulous opening is larger or 
smaller. 

* London Medical Gazette, Vol. XV. 



200 REMARKS ON PNEUMOTHORAX. 

Mr. Guthrie, in the London Medical and Sur- 
gical Journal, 1833, asserts that Laennec, and 
also all who hold that metallic tinkling < depends 
entirely on the passage of air through a hole in 
the lung into the cavity of the thorax,' have 
been mistaken, and in opposition to this he 
mentions that to produce the sound in question, 
the air in the cavity must necessarily be com- 
pressed. ' I do not,' says he, ' deny the facts of 
the air, the hole in the lung, or the fluid ; but I 
believe that to produce the sounds of the Jews' 
harp (metallic tinkling) the air in the cavity 
must be greatly compressed.' 

M. Beau, a French writer on the causes of the 
respiratory bruits^ is not satisfied with the ex- 
planation of Laennec, and contends that metal- 
lic tinkling is produced by a bubble of air, 
which having traversed the fluid, bursts upon 
its surface. He founds his opinion on the fact, 
that he has never witnessed metallic tinkling, 
when the communication with the external air 
was above the level of the fluid. Dr. Spittsd, of 
Edinburgh, seems to have suggested this expla- 
nation of metallic tinkling by the bursting of air 
bubbles, as early as 1830. 



REMARKS ON PNEUMOTHORAX. 201 

Magendie, in his lectures quoted in the Lan- 
cet of 1835, says : * The causes which produce 
the Hntement metaUique^ are not by any means 
well understood. Suppositions have been made, 
(they are made and abandoned with surprising 
fieu^ility in medicine,) but when we come to ex- 
amine them, we find nothing but mere theories 
without any shadow of proof.' He tells us that 
the supposition that a drop of liquid sticks to 
the upper part of a cavity and then falls into 
the fluid below, is mere hypothesis, which may 
or may not be true. He also denies the suffi- 
ciency of the explanation that the tinkling is 
caused by a bubble which traverses a fluid, and 
bursts upon its surface. His objections are 
grounded on an experiment, which he proceeds 
to repeat in presence of his class, showing the 
insufficiency of both these causes to produce 
metallic tinkling. In a dead subject, a quantity 
of fluid amounting to about half a pint was 
thrown into the chest. A perforation was then 
made through the pulmonary tissue, so as to 
establish a communication between the bronchi 
and cavity of the chest. A quantity of air was 
then forced in through the trachea, so as to enter 



202 REMARKS ON PNEUMOTHORAX. 

the pleural cavity. No metallic sound was pro- 
duced in the operation. Water was then drop- 
ped in through an opening in the upper part of 
the chest upon the fluid below, but this also 
produced no tinkling. Another orifice was 
made in the lung beneath the surface of the 
fluid, and air injected as before. A bubbling 
«ound, or ^craquement' was heard in the chest, 
but nothing of a metallic or tinkling character 
could be perceived. Magendie considers him- 
self as having disproved the explanations to 
which his experiments relate, but he does not 
offer any new one of his own. 

In regard to M. Guthrie's explanation, which 
supposes the necessity of compressed air being 
present, this has been effectually set aside by 
the fact, that although in extreme pneumotho- 
rax, the air in the pleura is moderately com- 
pressed, yet metallic tinkling is known to be 
also produced in large tubercular cavities of the 
lungs, which communicate freely with the at- 
mosphere, and therefore are not subject to any 
compression whatever. 

The solution of this phenomenon given by 
Dr. Davies, and Laennec Junior, that it is cans- 



REMARKS ON PNEUMOTHORAX. 203 

ed by the resonance of air, agitated upon the 
surface of a liquid, seems to be too vague and 
ansupported to require particular attention. 

In regard to the explanations given by Drs. 
Williams and Houghton, which ascribe metallic 
tinkling to an echo, or reverberation of air from 
the sides of a cavity, the solution seems to me 
bo be neither adequate nor very probable. Echo 
« the secondary sound produced by the refleet- 
*d vibrations of the atmosphere. It becomes 
K>\^erful only when many reflections converge 
x>\irards the same point. Air, moreover, is a 
Teeble conductor of sound, when compared with 
liquid or solid bodies. It is unnecessary, there- 
fore, to suppose that one of the most striking 
sounds heard in auscultation, is produced by the 
secondary movement of a feeble conductor, 
vhen we have between the ear and the place of 
impulse, the direct agency of a much more pow- 
erful conductor, viz. a liquid. To elucidate 
^is point, let any one perform the following 
experiment. Into a large earthen or porcelain 
bowl, pour a few ounces of water. Then pro- 
duce a slight and barely audible sound, by rub- 
bing or snapping together the ends of the nails 



204 CASES OF PNEUMOTHORAX. 

of the thumb and finger. If this sound is made 
in the air in any part of the cavity of the bowl 
above the water, it remains feeble, but if the 
nails be immersed below the surface of the wa- 
ter, the sound instantly becomes augmented to 
many times its former intensity, and it will be 
particularly intense to the ear of an ausculter 
applied to the outside of the bowl. Here, then, 
is a parallel case. The liquid in Pneumothorax 
and not the air, as will hereafter be seen, con- 
veys the sound of metallic tinkling to the walls 
of the chest, and these transmit it to the ear of 
the ausculter, constituting an uninterrupted 
chain of vibrations. 

Considering the subject as being yet imper- 
fectly explained, and therefore open to further 
inquiry, I have made some experiments in con- 
nection with the following cases, which I hope 
will not be found irrelevant to the question. 

Case L — J. B., cordwainer, aged forty-four, 
entered the Massachusetts general hospital, De- 
cember 28th, 1836. He had been troubled with 
cough and dyspnoea, during most of last year, 
increased during summer. Yesterday, after ex- 



CASES OF PNEUMOTHORAX. 205 

posure to cold during perspiration, had a sudden 
increase of cough and dyspncsa with pain shoot- 
ing from side to side, and hoarseness. Now, 
skin hot and dry, face flushed, pulse 98, respira- 
tion short, quick, 50 per minute, cough hard, 
with viscid frothy mucous sputa. Complains of 
pain in head and across hypochondria increased 
hy upward pressure or cough, tongue white, 
costiveness, dysury with frequent micturition. 

29th, Slst. Percussion dull on right back, 
enfficiently resonant on left Respiration very 
feeble in right back, with a slight bronchial 
sound opposite spine of right scapula. Bron- 
chophony well pronounced in same place. Sup- 
plementary puerile respiration in left back. 
Hoarseness amounting to aphonia, cough fre- 
quent, painful, with dyspncsa. About §ii. of 
muco-purulent sputa daily. Costive ; sleeps 
little. 

January 2d, 1837. Has rested and felt some- 
^xrhat better for two days. In right back respi- 
ration nearly inaudible, but voice and cough 
distinctly amphoric. 

4th. By degrees the respiration in right back 
has grown more audible, and amphoric. Per- 



206 CASES OF PNEUMOTHORAX. 

cussion resonant. In left back voice natural 
respiration puerile. Purulent sputa, one to thr 
ounces. 

5th, 8th. Metallic tinkling in right back, ai^V 
lower edge of scapula, slight and few, heard on^^ 
each day. Amphoric respiration; voice anc^M 
cough audible from summit to base of right^^ 
chest. Dyspnoea and cough more easy. Per— ^ 
cussion of right back tympanitic to base o£r 
chest ; right back when viewed vertically much 
more prominent to the eye than left; semi- 
circumference an inch greater ; intercostal spaces 
prominent, the anterior ones level in supine pos- 
ture. In erect posture, base of right chest less 
resonant than when lying on face or left side. 

9th. Paroxysms of great dyspncea, obliging 
him to get out of bed. Breath, voice and cough 
amphoric from summit to base of right back. 
Frequent metallic tinkling. Resonance of front 
and back, of right side on percussion. Purulent 
sputa, §iss. 

11th. Rested better; pulse 104; anterior 
right chest tympanitic on percussion, with in- 
audible respiration from top to base ; voice 
3ely audible through parietes at same place, 



CASES OP PNEUMOTHORAX. 207 

bat towards base amphoric. Respiration in 
right back feeble, but amphoric, accompanied by 
continual metallic tinkling, frequent and rapid, 
resembling the boiling of a fluid in a glass re- 
tort or flask. Respiration highly puerile in 
whole left back ; slight gurgling under clavicle. 
Very great exhaustion and anhelation, after 
rising to cough. Generally unable to expecto- 
rate unless he turns upon his left side, after 
which movement the pus flows freely. 

12th, 13th. Many turns of violent and suflb- 
cative dyspncsa ; metallic tinkling softer. Res- 
piration in right back very feeble, in left back 
puerile. 

14tb, 16th. Breathes with more ease. Some 
ounces of purulent sputa raised each day. Am- 
phoric or metallic respiration, voice and cough, 
'^^itb metallic tinkling more rare and feeble. 
Right anterior chest quite resonant on percus- 
sion, to the extreme base of the chest on inspi- 
r&tion, but about an inch less in extent at expi- 
mtion. 

from this time he continued delirious, with 
oocasional twitching of muscles; respiration 
hi^h and rapid ; inaudible, or amphoric, in right 



206 CASES OP PNEUMOTHORAX. 

cussion resonant. In left back voice natnral,^^ t 
respiration puerile. Purulent sputa, one to three ^^ 
ounces. 

5th, 8th. Metallic tinkling in right back, at " 
lower edge of scapula, slight and few, heard on 
each day. Amphoric respiration; voice and 
cough audible from summit to base of right 
chest. Dyspnoea and cough more easy. Per- 
cussion of right back tympanitic to base of 
chest ; right back when viewed vertically much 
more prominent to the eye than left; semi- 
circumference an inch greater ; intercostal spaces 
prominent, the anterior ones level in supine pos- 
ture. In erect posture, base of right chest less 
resonant than when lying on face or left side. 

9th. Paroxysms of great dyspnoea, obliging 

» 
him to get out of bed. Breath, voice and cough 

amphoric from summit to base of right back. 
Frequent metallic tinkling. Resonance of front 
and back, of right side on percussion. Purulent 
sputa, §iss. 

11th. Rested better; pulse 104; anterior 
right chest tympanitic on percussion, with in- 
audible respiration from top to base; voice 
scarcely audible through parietes at same place, 



CASES OP PNEUMOTHORAX. 207 

bat towards base amphoric. Respiration in 
right back feeble, but amphoric, accompanied by 
continual metallic tinkling, frequent and rapid, 
resembling the boiling of a fluid in a glass re- 
tort or flask. Respiration highly puerile in 
whole left back ; slight gurgling under clavicle. 
Very great exhaustion and anhelation, after 
rising to cough. Generally unable to expecto- 
rate unless he turns upon his left side, after 
which movement the pus flows freely. 

12th, 13th. Many turns of violent and suflb- 
cative dyspnoea ; metallic tinkling softer. Res- 
piration in right back very feeble, in left back 
puerile. 

14tb, 16th. Breathes with more ease. Some 
ounces of purulent sputa raised each day. Am- 
phoric or metallic respiration, voice and cough, 
with metallic tinkling more rare and feeble. 
Slight anterior chest quite resonant on percus- 
sion, to the extreme base of the chest on inspi- 
ration, but about an inch less in extent at expi- 
r-ation. 

From this time he continued delirious, with 
occasional twitching of muscles; respiration 
high and rapid ; inaudible, or amphoric, in right 



210 CASES OF PNEUMOTHORAX. 

red spots about the small curvature. Mucous 
membrane of small intestines healthy. 

. Case IL — I. C, aged forty-four, sailor, entered 
the hospital May 28th.* He was previously in 
the house three months ago with cough, and 
slight tuberculous signs. He now reports that 
he kept at work continuing pretty well until 
May 24th, when he tmd headache and dizziness 
in the afternoon, referred to having got wet in 
the rain the night before ; in the evening faint- 
ed, and in the night had coughing and retching; 
raised without pain §ss. more or less of frothy 
blood ; has had much cough since, mostly in the 
night, with scanty expectoration of frothy mu- 
cus; cough and long inspiration have caused 
pain in the right side, and across the chest ; has 
had no other pain, no chills nor flushes ; but has 
perspired considerably ; has had little appetite 
and much thirst, bowels have been open daily; 
urine high colored; feels very weak; tongue 
clean for most part, a little coated at roots; 
pulse 118. 

* This case was most of the time under the care of Dr. H&Ie. 



CASES OF PNEUMOTHORAX. 211 

29th. Slept better than out of hoase, but 
eoughed considerably towards morning. 

30th. Rested badly from great dyspnoea, 

v^hich came on between nine and ten last night; 

bathed in a sweat; pulse 96; mucous rale in 

the throat ; amphoric sound in respiration below 

left scapula; percussion resonant in the same 

place ; respiration puerile on the other side ; lies 

on the right, much distressed by lying on the 

back or left side. Half a pint of thin mucous 

fluid sputa, frothy on top and opaque. 

31st Rested badly from dyspnoea, requiring 

*^im to maintain a stooping posture ; five or six 

^€Jections ; pulse 132 sitting up ; dyspnoea now 

-'^ss urgent; a highly distinct metallic tinkle 

*^€ard in the left chest, disappearing when he 

^toops forward, returning as he bends back. 

^^ list below the angle of the left scapula strong 

^-mphoric respiration with clear metallic tinkle. 

'^^ axillary region sound as of striking a brass 

^^^ssel with a nail ; great resonance of the left 

^^lest, both behind and in front, on percussion. 

^^trongly puerile respiration in the right back. 

June Ist Slept half the night, by intervals, 
fitting up and stooping forward. No dejection ; 



212 CASEfl OF PNEUMOTHORAX. 

pulse 144 ; tongue moist, thick coat on centre, 
livid ; countenance distressed, anxious ; respira- 
tion 32, laborious ; no pain when at rest^ but on 
motion sharp pain through the left chest, below 
the region of the heart ; speaks only in a whis- 
per; feet and ankles oedematous; w^hole left 
chest, both front and back, very resonant ; respi- 
ration amphoric, with metallic tinkling loud and 
musical in the whole left back below spine of 
scapula, and whole left front from clavicle down- 
wards. 

2d. Slept pretty well in the same posture as 
last night; two dejections; countenance anx- 
ious; skin warm, with profuse perspiration; 
pulse 144 ; tongue white in centre, livid, moist ; 
respiration 30, laborious ; voice better than yes- 
terday ; amphoric resonance diminished ; metal- 
lic tinkling as yesterday. 

3d. Slept pretty well in his chair, as before ; 
pulse 128; respiration 32, somewhat less labori- 
ous, except after coughing ; unable to lie down; 
cough not frequent, but paroxysms long and 
severe ; percussion every where very resonant 
in left chest except for a small space about spme 
of scapula, where it is only equal with the right; 



CASES OF PNEUMOTHORAX. 213 

resonance continues to the very base of chest ; 
respiration vesicular, but feeble about spine of 
scapula ; amphoric in lower half of back ; natu- 
ral respiration without metallic tinkle ; after 
coughing large and musical tinkle ; in front no 
respiration heard below line one inch below 
nipple, above that metallic tinkle for the space 
of two or three inches, and above amphoric reso- 
nance in natural respiration; in forced respira- 
tion metallic tinkle over whole left chest; no 
resonance of voice ; in right chest respiration 
puerile. 

4th. Slept pretty well in posture as for the 
last four nights ; countenance less distressed ; 
pulse 124 ; cough less difficult, but still labori- 
ous ; about 3iss. of adhesive muco-purulent 
sputa ; skin moist and warm ; resonance of left 
back less than for some days past, though still 
greater than natural except about scapulae ; im- 
mediately over and above scapulae, percussion 
nearly or quite equal in both backs ; on two 
lower ribs of left back percussion resonant while 
leaning forward, fiat on leaning backwards; 
respiration in left back vesicular about scapulae 
a.nd for an inch or two below, then amphoric for 



214 CASES OF PNEUMOTHORAX. 

a space about the breadth of the hand, inaudible 
at base ; no resonance or tremor of voice disco- 
vered either in back or side ; metallic tinkling ' 
in front as before; also in back after cough.^ 
Sudamina above and about clavicles. 

5th. In bed most of the night lying on right 
side ; slept two or three hours ; four or five de- 
jections ; countenance improved ; gii. of adhesive 
muco-purulent sputa; pulse 108; tongue clear 
at edges, moist, coated in centre; percussion 
resonant down to sixth rib in left chest; flat 
immediately below; equal in both backs over 
scapulse, and for two fingers' breadth below; 
below that much more resonant on left side, 
down to last rib, while leaning forward* When 
leaning back, more dull in the whole of the reso- 
nant space in back. Natural respiration vesi- 
cular about scapulae, with sonorous rale ; below 
scapulae, amphoric resonance. In front, metal- 
lic tinkle after cough ; metallic tinkle also in 
back. No resonance of voice at base of chest. 

7th. In chair all night ; slept three hours at 
intervals ; five dejections ; countenance more 
distressed ; pulse 132 ; respiration 36, more la- 
bored than for the last two or three days. 



CASES OF PNEUMOTHORAX. 215 

Tongae cleaner, rather less livid ; nearly gii. 
adhesive sputa ; coughs, he thinks, about once 
an hour ; percussion dull in back on lower rib, 
when leaning forward ; respiration amphoric 
both in front and back ; natural breathing unac- 
companied by tinkle. 

8th. Kept awake by difficulty of breathing. 
Ck)ugh less; expectoration about §i. adhesive 
purulent mucus. Countenance much distressed, 
pulse 182 ; tongue more coated ; respiration 32, 
labored. Hair, skin and clothing wet with per- 
spiration. In natural respiration very little 
sound perceived, except some amphoric reso- 
nance and occasional metallic tinkling. Per- 
cussion, when leaning much forward, flat on 
lower rib, resonant above; when sitting up, 
flat on four lower ribs. A peculiar metaUic 
ringing sound perceived by ear applied to ster- 
num, when the back is percussed. 

11th. In chair all night; slept none from 
dyspnoea ; some pain in left chest ; two dejec- 
tions ; countenance much distressed ; coughs 
little ; expectoration pretty easy ; gii. of adhesive 
muco-purulent sputa ; pulse 144 ; percussion 
flat below nipple, also in back below corres- 



216 CASES OF PNEUMOTHORAX. 

ponding line, resonant above; sonorons ralefi 
in whole front chest. No other sound in natu- 
ral breathing. Amphoric resonance in back, , 
feeble in natural breathing, loud and musical 
after cough. After speaking, metallic tinkling 
in front 

12th. Lay on couch all night without having 
head much raised. Could lie on left side as 
well as right, the first time for several weeks. 
Rested very well, but did not sleep much ; one 
dejection ; respiration 36, somewhat labored, 
but less so than for several days past. Counte- 
nance less distressed ; pulse, after waking, 108; 
tongue much less livid, moist, with a broken 
coat in centre. Percussion of left chest (still 
lying on left side) quite resonant, except at most 
dependent part of side, where it is flat. In 
natural respiration, the only sound heard is sibi- 
lant rale both in front and back. Forced respi- 
ration, either in speaking or other effort, ampho- 
ric. Coughed but little ; less than §1. adhesive, 
white, firothy, mucous sputa. Immediately after 
rising, loud, ringing, amphoric resonance in res- 
piration, and especially in cough, heard both in 
back and front. Limit of flat sound on sitting, 



CA8S8 OF PNEUMOTHORAX. 217 

on a line an inch below the nipple. Same 
metallic ringing sound on percussion of chest as 
before. 

13th. In erect posture most of night ; slept 
little from dyspnoea; three dejections. Dis- 
charge from bowels thin and watery; counte- 
nance moderately distressed; perspiration not 
excessive ; pulse 116, tolerably full ; respiration 
36, high, laborious. In erect position, resonance 
on percussion extends down to one finger's 
breadth below nipple. Below this line, inter- 
costal spaces on a level with ribs ; above, inter- 
costal spaces projecting, resonant In ordinary 
respiration, amphoric resonance loud and dis- 
tinct in upper part of chest A ringing sound, 
on percussion, as before. No metallic tinkling 
heard. Abdomen full, moderately resonant 

14th. Slept very well, lying down, on either 
side ; four dejections. Countenance less dis- 
tressed ; feels better ; pulse 108 ; respiration 36, 
moderately labored. Inspiration and expiration 
nearly equal. Percussion flat below line, a fin- 
ger's breadth below nipple, resonant above. 
Same ringing sound as before, on percussion. 
Sounds of fluid readily distinguishable on sue 




218 CASES OF PNEUMOTHORAX. 

cnssion, heard with ear at a distance of a foot 
from chest. Moderate amphoric resonance 
ordinary respiration. Two sides of chest nearl]/ 
equal on measurement ; left mamma more prom— - 
inent to the eye than right, intercostal space^i^ 
protruding slightly. After some fatigue, am— -^ 
phoric resonance, ringing. Ribs of left chest^^ 
scarcely raised in respiration. 

15th. Slept pretty well, mostly in sitting" 
posture; three dejections. Breathing more dif- 
ficult when he attempted to lie down. Coun- 
tenance anxious and distressed ; skin quite jcooI^ 
wet with perspiration; large sudamina about 
clavicles ; respiration 36, laborious. Inspiration 
quicker than expiration. Cough little. Percus- 
sion about spines of scapulae still equal on both 
sides. Ordinary respiration amphoric and ring- 
ing ; when a little forced, voice and percussion 
ringing as before. Sound of fluid on succussion 
heard at distance of several feet. 

17th. Slept most of night in sitting posture 
and recumbent, lying on back or right side. 
Countenance much distressed; respiration quite 
laborious ; inspirations quick ; pulse 112. 
Tongue moist, slight coat on lobes, very slightly 



CASES OF PNEUMOTHORAX. 219 

livid ; skin cool and moist Pain near left nip- 
ple if he lies on left side ; no pain when at rest 
in any other position. Very little cough, gii. 
frothy mucous sputa. Line of flat sound level 
with nipple ; respiration in right chest loud and 
coarse. Sounds in left chest as before. Ring- 
ing sound on percussion perceptible when per- 
cussion is on same surface with ear, in erect 
position. 

18th. At six and a half A. M. found lying 
on back with shoulders raised, breathing quick 
and with tracheal rale. Eyes closed ; pulse very 
small and feeble ; extremities cold. Died soon 
after. 

Autopsi/j eight hours post mortem. Body not 
much emaciated, skin livid, lower extremities 
(edematous. 

Left chest quite resonant to a line with axilla, 
flat behind this line. Right side dull over whole 
space below pectoral muscles. The air rushed 
out from a perforation on left side, as detailed 
in Experiment I. Left pleura universally in- 
flamed, mostly red and roughened, and lined 
with a soft, bluish-white false membrane of 
variable thickness, separable in some places into 



220 OAfiBS OF PNEUMOTHORAX. 

layers, containing about five pints of thin, puru- 
lent, inodorous liquid, with coarse masses of 
lymph lying loose in the depending parts. Leffc "^ 
lung collapsed very small, fleshy, bluish-black, <^« 
pressed against spine and ribs, and nearly des- 
titute of air, having a coat of lymph, and ad- 
hering behind superiorly. A rounded fistulous 
opening was found, half a line in diameter, and 
situated on the posterior surface of the lower 
lobe, an inch and a half below its summit 
Through this orifice air issued, if blown into 
the trachea, and a probe pressed upwards enter- 
ed a large bronchus. This opening communi- 
cated immediately with a superficial cavity an 
inch long by half an inch broad, and which con- 
tained a whitish, friable, opaque substance. No 
other cavity was found, but small tubercles and 
gray granulations in various parts of this lung. 
The bronchi contained bloody fluid, were pale, 
thin and polished, excepting that which led to 
the cavity, and which was thickened, darker, 
and less polished. 

Right lung universally adherent by pale, soft, 
friable, recent membrane, forming bands below, 
some of them an inch long, among which were 



CA8E8 OF PNEUMOTHORAX. S21 

cavities, containing gviii. of reddish fluid. This 
lung contained many tubercles, and a cavity an 
inch long at its apex. 

In front of the neck was a tumor, occasioned 
by an abscess situated between sterno-hyoid 
muscles, containing Sss. of pus, with a lining of 
tuberculous-looking matter. 

Pericardium pushed to the right side, more 
than two-thirds of it beyond the median line. 
Heart healthy, except perhaps slight hypertrophy 
of left ventricle, which measured five-eighths of 
an inch thick at base, and five-sixteenths at 
apex. Weight, nine and a half ounces. 

Liver somewhat enlarged, rather dark, pushed 
down within an inch or two of the umbilicus. 
Small intestines tuberculous, especially on Pey- 
er's plates, towards the end of the ilium, but no 
ulcers. Other viscera mostly natural. 

Case IIL^- A. C, a young gentleman, aged 
twenty, called me to visit him June 28th, having 
just returned from a journey to the South. He 
reported, that two years previously he had bad 
a 'lung fever,' since which time his health has 
not been good. Last summer he was troubled 



222 CASES OF PNEUMOTHORAX. 

with slight pains in the chest, emaciation, L 
of strength, and some hectic symptoms, bui 
does not recollect much cough. Being consid 
ered phthisical by his physician, he had bee 
advised to pass the winter in the southern states— 

My first visit was made to him on the second 

day after his return, and one day before hi^ 
death. I found him thin and feeble, barely abl& 
to sit up, with a hot skin and circumscribed 
redness on his cheek. Dyspnoea by no means 
urgent, decubiture dorsal, pain and stricture 
across both hypochondria, and none felt else- 
where ; pulse 80. Left chest tympanitic, respi- 
ration inaudible ; a slight metallic tinkle heard 
singly at each inspiration and expiration. Pul- 
sations of heart feeble in cardiac region, stronger 
on right side. On the following day, without 
any great aggravation of dyspnoea or distress, 
he became much prostrated, with a small, irreg- 
ular pulse, cold sweats, and diminished sensi- 
bility, and died on the succeeding night By 
his own testimony and that of his friends, his 
cough had been slight, and the dyspnoea at no 
time urgent 

Autopsy^ sixteen hours after death. The 



CA8E8 OF PNEUMOTHORAX. 223 

whole anterior chest resonant, the left tympa- 
nitic. On perforating the left chest through 
water, great quantities of air escaped. [See Ex- 
periment L] The quantity of sero-purulent 
fluid was not estimated, water having been 
thrown into the chest for the sake of the ex- 
periment.- The left lung was adherent supe- 
riorly and posteriorly, and had tubercles and 
cavities in its upper lobe. The lower part of 
the same lobe was indurated by tuberculous 
infiltration, and had about the color of gray 
hepatization. No communication between the 
bronchise and chest w^as detected except those 
produced in the cavities torn in the separation. 
Bight lung healthy, excepting a few tuberculous 
lamps in its upper lobe. The heart was very 
small and flaccid, and was pushed almost 
wholly into the right chest. Mitral valves some- 
what thickened at their roots with slight vege- 
tation. Liver depressed, dark purple, flaccid. 
Grall-bladder healthy. 

I consider the last case as noticeable for the 
absence of any great dyspnoea or distress, after 
the signs of pneumothorax were so distinct as 
to lead to an unequivocal diagnosis of that dis- 



224 GA8B8 OF PNEUMOTHORAX. 

ease. I have seen similar cases where the pnetc^^ 
mothorax was partial, owing to the adhesions 
of the lung preventing collapse, a case no*^ 
wholly uncommon. 

Experiment I. — Previously to the autopsies 
of the patients who were the subjects of Cases 
I. and IT., a glass cylinder, open at both ends^ 
was pressed into close contact with the chest, so 
as to hold water. Some ounces of that fluid 
were poured in, and a perforation was made 
through it, into the cavity of the chest on the 
distended side. Immediately a large volume of 
air escaped from the chest, bubbling upwards 
through the water. In the third case, no cylin- 
der being at hand, a superficial cavity was made 
out of the dissected integuments of the chest, 
and filled with water. Through this water a 
perforation of the chest was made on the left 
anterior surface. The air rushed out, producing 
strong ebullition, as in the former cases. The 
experiment was then repeated on the right side, 
and the perforation made through water as be* 
fore. No air in this instance escaped, but the 
water was immediately sucked into the chest 
by the atmospheric pressure. 



EXPERIMENTS. 225 

Experiment II. — Artificial respiration was 
produced in the body of the subject of Case II., 
by inflating the lungs through the trachea, and 
expelling the air by pressure on the abdomen. 
At each inflation, a most distinct, clear and 
abundant metallic tinkling was produced, ac- 
companied with more or less amphoric sound, 
and could be sustained ad libitum by repeating 
the inflation. Thtf sound was recognized by 
several of the medical gentlemen attached to 
tlie hospital,* as being the same which had ex- 
isted during the patient's life. 

This experiment was repeated in the exam- 
ination of the body of the patient in Case III. 
It produced amphoric sound, but no tinkling. 
The latter symptom, it will be observed, was 
but feebly perceptible in examinations during 
life. 

Experiment III. — Through an aperture in 
the anterior part of the chest in the subject of 
Case IL, a catheter was introduced and air 
blown through it into the cavity of the left 
pleura. While the end of the catheter was 

* Among the gentlemen present were Drs. Hale, Strong, 
fiowditoh and Sargent. 
15 



226 CASES OF PNEUMOTHORAX. 

above the level of the fluid, a strong amphoric 
buzzing was communicated to the ear of an ob- 
server in contact with the chest. But when the 
end of the instrument was pushed below the 
surface of the liquid, and the latter made to 
bubble by continuing the inflation, an exquisite 
metallic tinkling was heard at the explosion of 
each bubble, resembling, as it had done in 
life, the sound of a little &ell or musical wire. 
In the subject of Case III. this experiment 
was repeated, and varied by pouring into the 
chest different quantities of water. When a 
few ounces only were present, metallic tinkling 
was uniformly produced, but when two quarts 
or more were introduced, a bubbling only was 
heard, without metallic resonance. Similar re- 
«ults were also obtained by pouring a small 
fitream, or letting fall drops of water from above 
upon the liquid in the chest. 

Experiment IV. — Succussion and percus- 
sion were both found to produce the same me* 
tallic sounds in the dead body as during life in. 
Case 11. Metallic sounds elicited by percussion 
somewhat resemble those occasionally yielded 
by the heart, and, as has been observed by 



EXPERIMENTS. 227 

Bouillaud, these may be imitated by percussing 
the back of the hand pressed closely upon the 
ear, or by closing both ears with the palms of 
the. hands, and walking on a carpet in a still 
room. 

Experiment V. — In the body of a person 
recently dead from accident, having no pneumo- 
thorax, a repetition was made of several of the 
foregoing trials. Air and water were forced 
into the chest, the Tormer so as to distend the 
cavity and render percussion quite resonant 
EbulUtioa of the fluid was then produced by 
blowing through a tube inserted between the 
ribs and pushed below the surface. The only 
result was a bubbling noise, having not the 
slightest metallic character. It will be observed 
that this was nearly a repetition of Magendie's 
experiment, and it probably failed to produce 
metaUic sound for the same reason as in that 
case, viz. that the patient was not pneumotho- 
racic. 

Experiment VI.— A bladder, and afterwards 
a stomach, each containing a few ounces of 
water, were inflated until thoroughly distended. 
Whenever the inflating tube was pushed below 



228 CASES OF PNEUMOTHORAX. 

the surface of the liquid, and the inflation con- 
tinued so as to produce bubbles, a sharp tink- 
ling was heard upon the explosion of every 
bubble, by the ear applied as in ansculting to 
the outside of the bladder. In this experiment 
the sound becomes more exquisitely metalU^^ in 
proportion as the tension of the bladder i& in- 
creased by farther inflatioOi Succussion of tfce 
bladder produces a similar, effect. It is neces- 
sary that a recent bladder shoi^d be used, the 
texture and elasticity of which are not altered 
by drying. When the orifice of the tube is 
above the surface of the water, also when no 
water is present in the bladder, an intense am- 
phoric sound is produced during, inflation; and 
if saliva or other liquid, in small quantities, ia 
blown through the inflating tube, a more feeble, 
or submetallic tinkling is produced. 

From the foregoing experiments and cases, 
we may infer that the following agencies are 
concerned in producing metallic sounds of the 
chest. 

1. There must be a cavity, the walls of which 
are preternaturally susceptible of vibratiofl' 



REMARKS. 239 

This takes place when the pleura is pathologi- 
cally distended, so as to overcome the obtuse or 
mnfBing effect of the contiguous soft organs, 
such as the lung, diaphragm and intercostal 
muscles. Some time is probably necessary to 
prepare the parts for this pathological resonance, 
since it fails to appear post mortem in healthy 
chests submitted to experiment. It should be 
added, that when metallic sounds appear in 
simple phthisis, there are cavities of the lungs, 
the walls of which are in a state of tubercular 
indnratiou. 

2. The immediate or exciting cause of metal- 
lic tinkling, is a forcible or sudden disturbance 
of the liquid in a vibrating cavity like that 
described. The explosion of bubbles of air 
from beneath the surface of the liquid, appears 
to be the most common cause of such a dis- 
turbance ; but it may also take place when a 
part of the liquid is thrown upward in the act 
of coughing and falls back upon the remainder. 
The same occurs in succussion of the chest 

3. The vibrations which yield metallic tink- 
ling are transmitted from the liquid to the solid 
parietes, and thence directly to the ear, without 



230 KEMARK8 ON PNEUMOTHORAX. 

mny oeoessaiy agency of a» echo, or reverbera- 
tion of air in the carity. This is shbwn partic- 
olaily by the experiment of the bowl, page 203. 

4^ A minor, or submetalUe tinkling, haying no 
mnsical resonance, may be produced by slight 
impulses given to the air in the cavity, such as 
the breaking of babbles of mucus at orifices 
above the surfBU^ of the liquid. 

5. Amphoric resonance is produced by rever-^ 
berations of the air in a vibrating cavity, with- 
out sonific impulse of the liquid. The same is 
true of metallic modifications of the voice, and 
of the cough when there is no tinkling. Metal- 
lic percussion seems also to depend upon tfaer 
vibrations of air independently of liquid, and 
may be produced in some other cases when we 
strike upon a tense cavity in which a certain 
quantity of air is confined. 



ON 



THE PHARMACOP(EIA 

OF THE 

UNITED STATES OP AMERICA. 

[nOK THE AMEEIOAN JOURNAL OF MEDIOAL BOIENOES FOB 1831 ] 

If the medical and scientific world were 
restricted to the most simple modes of expres- 
sion and inter-communication, if we possessed, , 
for example, but one nosology, but one system 
of natural history, but one language of chem- 
istry and pharmacy, it is obvious that the books 
which treat of those sciences would be greatly 
simplified ; that the labor of learners would be 
abridged, and much confusion prevented among 
those who respectively teach, or cultivate, these 
departments of knowledge. Of this fact the 
public are so well aware, that attempts have 



232 ON THE PHARMACOPGBIA 

been many times made to establish in these 
sciences standards of definite expression. Some- 
times under the sanction of governments, some- 
times from the influence of popular writers or 
teachers in science, and sometimes £rom the 
conventional authority of delegated bodies, a 
common language has been introduced, and 
obtained a degree of currency, w&ich, though 
seldom universal, has, nevertheless, been suffi- 
ciently extensive to produce a full proof and 
conviction of its utility. 

Unhappily, however, in those studies, the 
subjects of which are most multifarious and 
complex, and which therefore stand most in 
need of precision in their nomenclatures, an 
inexplicable confusion of language still exists. 
Mineralogy, zoology, and botany, particularly 
the two latter, in themselves no trifling subjects 
of labor, have been rendered to most persons 
absolutely insurmountable, by the cumbrous 
load of synonyms, which has been gradually 
accumulating upon them, under the agency 
of successive reformers. The Latin language, 
once the common medium of intercourse for the 
learned of all countries, has itself become a sort 



OF THE UNITED STATES. 233 

of Babel, fiirnishing, not unfrequently, a dozen 
incongraous names for the same object. And 
since neither Napoleon nor Nicholas, nor any 
general congress for the pacification of Europe, 
has taken in hand the reconciliation of conflict- 
ing terminologies, the republic of names still 
remains at the mercy of every innovator whose 
new colors may attract partisans and disciples, 
and increase the anarchy already existing. 

It is therefore sufficiently evident, that the 
language of the sciences which we have men- 
tioned, needs retrenchment quite as much as 
extension; and were it not for the fact, that 
certain nomenclatures have become incorpo- 
rated with books more useful than themselves, 
it would be a happy circumstance, if all of 
them, save one, could be consigned to oblivion. 
To determine what one in each particular case 
should supersede all the rest, might be as deli- 
cate an affair as to elect a president of the 
United States. But it is not the less true, that 
one, even though deficient and unacceptable, 
would be far better than many. 

Pharmacology, considered not only as a sci- 
ence, but as a medium of communication for 



234 ON THE PHARMAOOPGBIA 

two extensive professions, particularly needs 
simplicity and precision of language. It like-' 
wise requires that its expressions should be 
generally intelligible, an advantage which -can- 
not be secured, except by the introduction of 
a general standard, regulating the names as 
well as the selection and modification of its 
subjects. On this ground, it is presumed, there 
is ho variance of opinion. But when we arrive 
at the question, what the standard shall be, and 
who shall appoint it, the charm of unanimity is 
very apt to dissolve. 

It is not difficult to frame a competent phar- 
macopceia, which shall be abundantly adequate 
to the wants of the medical community. But 
to devise a plan by which its general adoption 
shall be secured, is a task which experience has 
proved to be attended with no ordinary diffi- 
culty. Local partialities, and an unwillingness 
to receive the supposed dictation of others, 
have, in more cases than one, frustrated the 
best contrived plans for promoting a general 
accommodation. And since indisputable per- 
fection is not to be expected in a pharmaco- 
poeia, there will always be found a spirit of 



OF THE UNITED STATES# 335 

hypercriticism, ready to consider trivial defects, 
as reasons for rejecting a public good. 

We hold it to be a maxim, that one standard 
of pharmacy, if sanctioned throughout a whole 
country, even though it be an imperfect one, is 
far more promotive of public convenience than 
a number of more learned and perfect ones 
existing simultaneously. The late autocrat, Al- 
exander, ordered his Scotch body-surgeon. Sir 
James Wylie, to prepare a Pharmacopoeia Ros- 
sica, which he introduced by an ukase through- 
out bis extensive dominions. This work, a 
copy of which has reached us, appears to be 
sufficiently respectable. But, without entering 
into its particular merits or demerits, we will 
venture to presume that the subjects of his 
hyperborean majesty have been enabled to com- 
pound and swallow their drugs with equal effect, 
and far less trouble, than those of the king of 
Grat Britain, speaking in the tongues of three 
different colleges. 

If the business of making a pharmacopoeia 
could be commenced dip novo, without reference 
to any of the standards now existing, the great 
question presented with regard to nomenclature 



236 ON THE PHARMACOPCBIA 

would be, whether names should be scientific, 
that is, in some measure descriptiye of the 
origin, character, and composition of medicines ; 
or whether they should be arbitrary, having no 
such reference or import In the former case, 
the names would be more expressive, and better 
suited to the dignity of science ; in the latter 
they would be more permanent, from not being 
connected with any fluctuating medium. 

To illustrate these positions, let us observe 
the revolution through which a single substance 
has been obliged to pass, in order to keep pace 
with the progress and improvements of science* 
Since the discovery of calomel, that article has 
been reformed by at least a score of successive 
appellations. In the figurative language of al- 
chemy it was known by the names of draco 
mitigatus, aquila alba, manna metallorum, &c. 
As chemistry grew somewhat more definite as 
a science, this substance became mercurius dul- 
cis, and mercurius dulcis sublimatus. Under 
the regime of Lavoisier and his cotemporaries, 
it was a muriate and a submuriate ; and after 
Davy and Gay Lussac, became a chloride and 
a proto-chloruret Lastly, as if the gentleness 



OF THB UNITED STATES. 237 

of its character was to produce a reconcilia- 
tion of extremes^ the mitigated dragon of anti- 
quity has become a mild chloride of mercury. 

On the other hand, when a nomenclature has 
been perfectly arbitrary and divested of scien- 
tific relations, it has been proportionally dura- 
ble and constant. Like the words engrafted on 
a national language, its origin may be vague 
and accidental, yet the public convenience pre- 
vents it from falling into disuse; and though 
it might, perhaps, be susceptible of reform, yet 
the benefit would not compensate the trouble. 
In regard to pharmacology, there is one lan- 
guage alone which has remained permanent 
Mdidst mutations, and which a hundred years 
JitkHi^not been able to shake from its basis ^x 
w^i^nean the language of commerce. This 
language, which is for the most part arbitrary 
and accidental, has seen many pharmacopoeias 
rise and fall, and is now quite as likely as any 
one of them to last for a century to come. 
The simple names of opium and alum, of calo- 
mel and camphor, have never yielded to any 
periphrastic method of expressing the same 
things. Corrosive sublimate refuses to be mod- 



on THB PHAmMAOOPiBIA 

emized, and the salts of Epsom and Rochelle 
maintain their giomid against all chemical in- 
terference. The combined learning of two hem- 
ispheres b miable to prevail against copperas 
and cream of tartar, and the manufacturer and 
merchant still continue to make, sell and buy 
their tartar emetic without troubling themselves 
to inquire whether it is a ^ tartrate,' or a ^ cream 
tartrate,' or neither. Nay, in some instances 
the vulgar appellations have turned the tables 
upon the classical and scientific, and the homely 
name of potash has dictated to the learned their 
more elegant potass and potassium. 

To combine in practice the expressiveness 
and precision of one language with .the dura- 
bility of the other, though very desirable, wottldi, 
from the nature of the subject, be impossible. 
Yet an approach may be made to the advan- 
tages of both, by adopting, in the first instance, 
a descriptive language founded on the existing 
state of science at the time, and afterwards to 
declare it perpetual, or at least to establish it 
in force during a long term of years. We should 
thus possess a medium of communication in 
itself entitled to respect, and rendered more 
valuable by the prospect of being permanent 



OF THE UNITED STATES. 239 

It appears to us, that the stability of pharma- 
ceutical language is a consideration of quite as 
much importance as its improvement. Great 
changes, in regard to any prevalent system, can 
seldom be effected without doing violence to 
established habits and preferences of the com- 
munity. An apothecary, whose drawers are 
labelled with the legitimate nomenclature of 
the day, and a physician, who for a score of 
years has employed a uniform phraseology in 
his prescriptions, are not compensated by any 
trifling advantage, for the risk and trouble of 
an entire change. Wherever, therefore, it ap- 
pears that a uniform system is extensively es- 
tablished in any country, it is incumbent on 
the friends of science to oppose all unnecessary 
deviation from the rules it prescribes. If the 
general progress of other sciences has been such 
as to require that pharmacy should be made to 
keep pace with them, its improvement ought to 
consist as far as possible in additions, syno- 
nyms, and commentaries, but not in great or 
violent changes. It is fortunate for the science 
of anatomy that its distinctive names have 
been handed down from one generation to an- 



240 ON THE PHARMACOP(EIA 

other with so little alteration; and we believe 
no reformer at the present day would obtain 
many proselytes, who should propose to abolish 
its nomenclature, because pia mater, os sacrum, 
ossa innominata, and similar names are absurd, 
misplaced, or unscientiiGic. 

In regard to preparations and compositions) 
it may often happen that improvements are 
necessary in pharmacy, to promote the economy 
and uniformity of certain results. Such changes 
are highly proper, provided they do not interfere 
materially with the standard of strength which 
has been previously current* But great changes 
in the strength of medicines may generally be 
regarded as pernicious, serving to perplex apoth- 
ecaries and deceive physicians, if not to kill 
patients. It is to be regretted that, in the dif- 
ferent pharmacopoeias which have been pub- 
lished among us, there are operative medicines 
bearing the same name, in some of which the 
strength is double that of others. As to the 
more complex medicinal formulae which crowd 
our books, it will be found that most of them 
owe their place in the shops to some fashion, or 
some traditional celebrity, rather than to any 



OF TUB UNITED STATES. 241 

exclnsive fitness or virtue ; and we may perhaps 
^et a tnie idea of their value from the consid- 
eration, that if, by any means, the knowledge 
of the whole of them should be lost, it is not 
probable, in the doctrine of chances, that one in 
fifty would ever be reinvented. Yet, since the 
prevailing traffic requires that they should con- 
tinue to be made and sold, it is important for 
those who consume them, that they should be 
exempt from fluctuations of character. 

In the United States, previous to 1820, there 
was no uniformity of pharmaceutical language. 
PharmacopcBias, indeed, had been adopted by 
medical bodies, in Massachusetts and some 
of the other States; and Dispensatories, both 
foreign and native, had been published among 
OS. But in the year referred to, an effort was 
made^ by which the consent of a great majority 
of the medical institutions of the country was 
obtained, for a plan of a national pharmaco- 
pceia. This, it was confidently hoped, by intro- 
ducing a current language throughout the coun- 
try, would do away the confusion which then 
prevailed, and offered to the parties concerned a 
fieu^ility of intercommunication, corresponding to 
16 



242 ON THE PHARMACOPCEIA 

that which results from a common system of 
coinage, or of weights and measures. A nu- 
merous and highly respectable ' delegation was 
appointed, from most of the principal States, a 
part of whom met in the city of Washington, 
at the appointed time. 

It may here be proper to inquire what such a 
convention could reasonably be expected to do, 
and what it was their duty to do, under the cir- 
cumstances in which they were placed. Com- 
ing together from remote places, and holding 
their session at an inconvenient sacrifice of time 
and expense, it was not to be anticipated that 
they would institute an original investigation of 
the whole subject. The ordeal of an experi- 
ment upon every doubtful subject, would have 
involved a labor of months, and perhaps of 
years. It would not reasonably be expected 
that they would produce a pharmacopoeia, 
which should be better than any which pre- 
viously existed. A debating assembly would 
be far less likely to do this, than a competent 
individual in his closet. Yet the convention 
possessed the power to confer a great good ; a 
power which no individual is likely to obtain, 



OF THE UNITED STATES. 243 

that of introducing order in the place of con- 
fusion, and law instead of anarchy. 

Under these circumstances, it was incumbent 
on them to produce, or sanction, some standard 
of pharmacy which should be adequate to the 
wants of the community. It was not very 
material what one, among many standards, 
they should adopt as their basis. They might 
have selected the Edinburgh Pharmacopoeia, 
which, though prolix in its expressions^ was at 
that time more current than any other in the 
country. Or they might have taken the London 
Pharmacopoeia, dogged as it has been by Mr. 
Phillips, and this would have served very well 
as the groundwork of a useful book. Or they 
might endeavor to frame a system of their oww, 
which, in some respects, might be superior to 
its predecessors, or at least better adapted to 
the customs and wants of our own country* 
The last plan was decided on by the convene 
tion, under the expectation, doubtless, that it 
would be more acceptable to their constituents. 
A programme of a pharmacopoeia prepared by 
the College of Physicians in Philadelphia, was 
adopted as the groundwork, and, after being 



'244 ON THE PIIARMACOPCEIA 

Tariously modified and augmented, was referred 
Tto a committee, with instructions to publish it. 
It must necessarily happen that a work ema- 
nating from so many disconnected sources, a 
part of whose contents must, from the natore 
of the case, be the result of compromise among 
the parties concerned, rather than of satisfac- 
tion to any of them, would be iii some respects 
imperfect, disconnected, and redundant. Nev- 
ertheless, if it was on the whole better suited 
to the occasion than any other work actually 
existing, the public were bound to receive it 
with complacency, as the only standard which 
.could ever become general among us. And if 
•criticisms were needed to point out the faults 
which it contained, they should have been 
made in a spirit of manliness and liberality, 
such as would have promoted the gradual re- 
form and perfection, rather than the over- 
throw of the work. But several of the journals 
lliought otherwise, and the pharmacopceia was 
obliged to undergo an ordeal, the severity of 
which far exceeded its deserts. The spirit of 
criticism was pushed with a zeal not according 
to knowledge, and in many instances the igno- 



OF THE UNITRD STATES. 245 

ranee of the commeiitator, rather than the de- 
fects of the book, produced a reprobation of its 
contents. Nevertheless, the pharmacopcBia was 
received, willingly by some, and reluctantly by 
others, and became, we have reason to believe, 
the prevailing standard, or at least more preva- 
lent than any other throughout the United 
States. 

It was to be hoped that, when the period 
should arrive which had been assigned by the 
convention for a revision of this work, a suffi- 
cient unanimity of sentiment would have pre- 
vailed, to direct into one channel whatever 
amount of skill and experience might be vol- 
unteered for its improvement, either by socie- 
ties or individuals. It appears that numerous 
societies, in different parts of the Union, feeling 
an interest in the revision and confirmation of 
the pharmacopoeia, had appointed delegates to 
attend the expected convention at Washington, 
in 1830. A part of the delegates thus desig- 
nated were, agreeably to the provisions made in 
1820, returned to the presiding ofiicer of that 
year. But a greater number, who had not been 
formally returned, proceeded to Washington at 



246 ON THE PHARMACOPCEIA 

the appointed time, and having organized a 
convention of such delegates as were present, 
and invited a cooperation of other medical gen- 
tlemen of eminence then in the city, proceeded 
to take measures for the republication of the 
work. In the mean time, a part of the delegates 
who had been officially returned to the former 
president, influenced either by convenience, or 
by the smallness of their numbers, determined 
not to convene at Washington, but held a meet- 
ing in New York, where they also proceeded 
to take measures for republishing the pharma- 
copcsia, having likewise invited the cooperation 
of other medical gentlemen of note. Out of 
this want of concord have risen up two phar- 
macopoeias, neither of which can strictly claim 
to be, by lineal descent, the legitimate heir of 
the original work ; one, proceeding from a body 
not formally declared elected to the convention 
at Washington ; the other, from a body who did 
not convene at Washington at all. We regret, 
during the long period of preparation, in which 
the proceedings of each party must have been 
known to the other, at least in a degree, that 
some compromise was not eflected, so that the 



OP THE UNITED STATES. 247 

objects of both might be effected, with less 
trouble to themselves, and less expense to the 
public It was not indeed in the power of the 
delegates at Washington to correct the original 
defect in their mode of election, but it was in 
the power of the delegates of New York to 
have gone to Washington, and there to have 
invited the cooperation of the other delegates 
present, especially as they appear not to have 
been afterwards fastidious in associating with 
their own body uadelegated individuals. Even 
after the original meetings had taken place, a 
slight spirit of conciliation in one or both par- 
ties, (we know not which was wanting in this 
respect,) would have produced harmony and 
unity in the end. 

As things now are, it appears to us that the 
two works must stand upon their respective 
merits, as pharmaceutic compositions ; and the 
public are called on to decide whether either, 
and if either, which one, is entitled to be re- 
ceived as the national standard. And here, if 
it be asked what constitutes fitness or excel- 
lence in a pharmacopoeia, we should answer 
simply, that such a work ought to contain and 



248 ON THE PHARMACOPCEIA 

identify the medicines which are commonly 
used by physicians, that its prepeurations should 
be scientifically composed, that its language 
should conform to the most current language 
of the day, and that it should be complete as 
a system in itself, that is, should have a cor- 
respondence between its own parts. In these 
respects, we think the Washington Pharma- 
copoeia has greatly the advantage of its com- 
petitor. We observe in its list of materia med- 
ica, comparatively few alterations of nsLmes, 
and these are made mostly in conformity to the 
present language of chemistry. In the New 
York edition the changes are exceedingly nu- 
merous, the new names being taken partly from 
the London Pharmacopoeia, and partly invented 
for the occasion, so that the book has the aspect 
of an edition of some other work, rather than of 
the American Pharmacopoeia. The references 
to authors, which are considered necessary by 
most pharmacologists, to identify the substances 
intended, are wholly omitted in this work. In 
regard to completeness and accuracy, the work 
of the Washington convention is prepared with 
-"uch care and science, and with a correspond- 



OP THB UNITED STATES. 249 

enoe of its different parts. In the New York 
edition we find a want of unity, such as attends 
hasty preparations, and a discordance often 
recurring between the names of the articles 
themselves and those of their preparations. 

In regard to the latter work, knowing the 
difficulties which attend this species of compo- 
sition, and entertaining a high respect for the 
character of the gentlemen concerned, we for- 
bear to fill our pages with commentaries on its 
redundancies and discrepancies. We shall not 
therefore complain because Burgundy pitch is 
inserted twice under different names, in the 
materia medica, nor because the sulphates of 
quinine and morphine, figs, prunes, and some 
other articles required in the preparations, are 
not inserted in the materia medica at all. These 
things must be corrected with their pens, by 
those who may employ the book. On the other 
hand, we are happy to perceive some improve- 
ments on the edition of 1820, in the greater 
accuracy of the chemical nomenclature, and in 
the introduction of some useful formulas. We 
think however that retrenchment, in the old 
work, was much more needed than augmenta- 
tion. 



250 ON THE PUARMACOPCEIA 

Believing that the pharraacopcBia produced 
by the Washington convention, being a more 
elaborate, accurate, and finished work, will 
eventually become the standard of the country, 
we propose to enter somewhat more at large 
into the consideration of its contents. This we 
shall endeavor to do with the impartiality which 
the subject ought to receive. 

In their preface this convention express their 
reasons for adopting as their basis the Phar- 
macopoeia of 1820, a work having many incon- 
veniences and defects, but at the same time 
many claims to approval. In its general out- 
line, say they, and prominent features, it will 
bear a favorable comparison with the best phar- 
macopceias of Europe, and it is only in filling 
up, that improvement is demanded, or admis- 
sible. The changes therefore which have been 
made under the authority of the late conven- 
tion, embrace the materials and minor arrange- 
ments, without extending to the general plan. 
In preparing for the press the present revised 
edition, the new convention inform us that 
much labor has been expended, and every part 
of the work submitted to the most strict and 



OF THE UNITED STATES. 251 

rigid scrutiny. Every accessible pharmaceutic 
authority has been consulted, and the accuracy 
of processes has been frequently tested by a 
practical investigation ; the several departments 
have engaged the attention of individuals pe- 
culiarly qualified by their previous studies, and 
the whole has passed the examination of phar- 
maceutists of acknowleged eminence in their 
profession. 

Considering how difficult it is to induce per- 
sons of the necessary competency to engage in 
gratuitous labors with perseverance and fidelity, 
we are happy that the individuals concerned in 
the present revision have devoted themselves 
with such singleness of purpose to the perfect- 
ing of the work. From our knowledge of the 
amount of labor actually bestowed on it, and 
.from the internal evidences which it bears of 
extensive inquiry and precise examination, we 
doubt whether any future convention will pre- 
sent us with results' more deserving of the 
public confidence. 

In pursuance of the plan of the former edi- 
tion, and for reasons which it is not necessary 
here to repeat, the pharmacopceia is written out 



252 



ON THE PHARMACOPCEIA 



on opposite pages in Latin and in English. 
The classical latinity of the London Pharma- 
copoeia is adopted as a standard, and, by keep- 
ing this in view, a unity of style is preserved 
throughout the book. We see no cause to be 
dissatisfied with the general purity and ^e- 
gance of this language, though in one case, we 
observe, the convention have erroneously fol- 
lowed the London example, in using the geni- 
tive 'rosmarini,' and ablative *rosmarino,* in- 
stead of the undoubted rorismarinij and rore* 
marinoy sanctioned by Horace, Columella, and 
other classics. 

In regard to names, the convention informs 
us in their preface, that for reasons which they 
discuss at length, they have adopted the mod- 
ern chemical nomenclature, in which the names 
are expressive of the composition of bodies. 
This was* in most cases done by the framers 
of the former pharmacopoeia, but in the present 
edition an attempt has been made to bring the 
nomenclature more completely in accordance 
with the best scientific usage. Thus we have 
chloride of sodium^ instead of muriate of soda; 
ferrocyanate of iron, instead of prussiate of iron, 



OF THE UNITED STATES. 253 

&c. In a few instances, however, to avoid great 
circumlocution, a pharmaceutical name is re* 
tained in the place of a more expressive chemi- 
cal appellation, as in the case of alumen, hy- 
drargyrum, ammoniatum, &c. In conformity 
with the present language of chemistry, the 
proportional composition of bodies, it appears, 
is intended to be expressed, and we have, 
among other things, a bicarbonate of potass, 
and a bicarbonate of soda. But this intention 
is not always execttted throughout the work, 
which seems to us a defect in uniformity. The 
substance called by this convention sulphate of 
copper is a bisulphate, and ought so to be 
called in a chemical nomenclature, since there 
is another sulphate, composed of one equivalent 
of acid and one of peroxide of copper, which 
is precipitated by adding pure potass to the 
solution of the bisulphate above mentioned, in 
a quantity insufficient for separating the whole 
of the acid. 

We know not for what reason it has been 
thought proper to omit, as synonyms, certain 
commercial names of common usage, while 
others, of much less frequent occurrence, are 



254 ON THE PHARMACOPCETA 

retained. The student of pharmacy who wonld 
know what is meant by Epsom salt, Glauber's 
salt, blue vitriol, and other names which meet 
him in the daily price current, must seek for 
information in other books than the American 
Pharmacopoeia. These names being interna- 
tional and long established, cannot, we think, 
with propriety, be given up in a work of general 
pharmacy. 

Ju the nomenclature of substances derived 
from the vegetable kingdom, the work before 
us adheres to the simple and appropriate plan 
of the first edition, that of using, in all practi- 
cable cases, a single word for the name of the 
drug, leaving its nature and origin to be de- 
fined in the opposite column. This peculiarity 
of the American Pharmacopoeia is one of its 
leading excellences, and one which the New 
York convention seem to have acted unwisely 
in abandoning. Most of the names used in 
other pharmacopoeias, to express vegetable sub- 
stances, are either unwieldy in their length, or 
improper in their application. Thus the drag 
assafoetida is called by the Edinburgh college 
gummi resina ferulae assafoetidee, a name which 



OF THE UNITED STATES. 255 

3 highly descriptive, but inapplicable to com- 
mon use. By the London college it is called 
issafoetidse gummi resina ; but as the term as- 
»af(Btida alone is not the name of any plant, 
in any botanical system of the present day, 
!;he whole name is incorrectly composed. The 
simple name of the drug, assafoetida, is un- 
loubtedly better than either. In like manner 
^lumbo may be called by the simple name 
x>lomba, or by the circuitous name cocculi 
)almata radix, but not calumbse radix, for there 
B no such plant as calumba. The American 
Pharmacopoeia has another advantage in using 
(imple names, whenever the drug happens to be 
leiived from several plants, as camphor, senna, 
beum, and aloe, or from several animals, ich- 
;hyocolla. In the present edition, a slight vari- 
ition is made from the former, in using the 
Latin name of the article always in the singular 
lumber, as cantharis, caryophyllus, prunum, 
Bstead of cantharides, &c. This method pre- 
serves uniformity, and is supported by the 
isa^e of Celsus in similar cases. 

As in the former edition, the materia medica 
ist is divided into two columns, the first of 



356 ON THB PHARMACOPCEIA 

which contains the officinal name of each a^ 
tide, in Latin and English, together with oc- 
casional synonyms, while the other defines the 
substance intended, and gives explanatory ref- 
erences. This part of the work gives evidence 
of a laudable degree of care and research, yet ^ 
we notice a few minor things deserving of re- 
mark. The substance called lupulin, derived ^ 
from the hop, is defined ^strobilorum pollen.' 
As the word pollen has, in vegetable physi- — 
ology, a specific meaning, it would have been — 

better to have used some other name to ex 

press powder. In the Latin, lupulia^ as used 
by the New York convention, is more conso- 
nant to morphia and quinia than lupulina. We 
see no reason for giving up spermaceti^ the 
universally received name, both in chemistry 
and commerce, and substituting cetaceum of the 
London college, a word which is neither more 
classical, nor more definitive. Scabious, applied 
to erigeron, is a provincial misnomer, that name 
belonging only to scabiosa. 

In regard to preparations, the convention 
considering this the most extensive and impor — 
tant part of the work, have devoted to it e^^ 



I 



OF THB VNITfiD 8TATK8. 257 

greater share of their attention. They inform 
us that examination has been carried into all 
its parts, and not a single process has been 
allowed to escape a close scrutiny. One of the 
most prominent defects of the original phar- 
macopceia was a want of uniformity, both in 
the manner of conducting the processes, and in 
the style of describing them. This arose from 
the variety of sources from which materials 
were drawn, and the want of due time to re- 
mould and shape them, so as to produce a 
harmonious whole. In the present edition an 
effort has been made to supply these deficien- 
cies, and to produce uniformity of language, as 
well as correspondence and unity of design, in 
the different parts of the work. In the selection 
of the . process for each preparation, two princi* 
pies are stated to have governed the choice of 
formulae, independent of their intrinsic merit, 
which, when superior, has always been allow- 
ed a predominating influence. When two or 
more methods of preparing the same compound, 
equally meritorious in themselves, have come 
under consideration, that has been preferred 
which has united in its favor the widest preva- 
17 



258 ON THB PHAHMACOPCBIA 

lence in this coantry, and the sanction of the 
majority of the British pharmacopoeias. It is 
considered highly desirable, that uniformity in 
the preparation of medicines should everywhere 
prevail, for the benefits accruing from the mu- 
tual interchange of the medical writings of 
difierent civilized nations, must be greatly af- 
fected by any material difference in the nature 
or composition of the remedies employed. This 
remark is especially applicable to Great Britain 
and the United States, and to all countries 
where the English language is generally used* 
It is a duty, therefore, say the convention, which 
we owe to the cause of pharmacy, to throw our 
weight into the scale which already preponde- 
rates, and thus contribute to the production 
and maintenance of the desired uniformity. 

In those cases where the chemical formulsB 
of the original pharmacopceia have been found 
to be defective or objectionable, their place has 
been supplied by more accurate and practicable 
rules, founded on a course of careful investiga- 
tions. In this way the economy and uniformity 
of certain processes is greatly promoted. New 
preparations, which have been brought to light 



OF THE UNITED STATES. 259 

by the uncommon progress of pharmaceutic 
investigations, during the last dozen years, are, 
in varions instances, inserted. Such are the 
preparations of iodine, qninine and morphine. 
The convention, however, have shown a wise 
forbearance, in not crowding their book with 
the host of new articles, often, we apprehend, 
more curious than useful, which modern chem- 
istry has been enabled to extort from vegetable 
drags. Retrenchment has been freely exercised 
in lopping off many of the superfluous formu- 
las, which a necessity for hasty compromise had 
caused to be introduced into the pages of the 
old pharmacopceia ; and, among other articles 
dismissed is the acetura opii, or black drop, a 
irevived piece of antiquity, wasteful in its com- 
position, and utterly uncertain in its strength, 
the place of which is now better supplied by 
the acetated tincture of opium, and the acetate 
of morphia. For ourselves, by the way, we 
lean to the opinion, that opium, to produce its 
full benefit, must be opium still, and we are 
not sure that any of the artificial salts of mor- 
phia are better than the natural meconate. We 
liave seen delirium tremens brought on under 



260 ON THE PHARMACOPCEIA 

the use of denarcotized laudanum. If the crude 
drug were cumbersome from the bulk necessary 
to form a dose, as in the case of cinchona, it 
would be highly useful to reduce its active in- 
gredient into a smaller compass. But this is 
not the case with many of the narcotics. 

Very complex medical formulas, such as 
abound among the old writers, and still encum- 
ber the pages of many of the pharmacopcBias, 
we deem to be a superfluous* appendage to 
medical science. One of the greatest modern 
improvements is found in the simplification of 
medical prescriptions. The art of prescribing 
appears to us a more simple affair than it has - 
been represented by the hypercritical pedantry 

of Dr. Paris. We admit that adjuvants will ^ 

help, and that corrigents will correct; never-— — 
theless, we find that castor oil, ipecac, and-^^ 
opium will often do their duty without either.——'* 
In admitting the influence of chemical consid-— "^ 
erations in the exhibition of medicines, it \%^^ 
important to recollect that the stomach has 
chemistry of its own, and that the digestive-: 
organs exert a material control over the forces 
of ordinary chemical agents, separating ele- 



OF THE UNITED STATES. 261 

ments which have strong mutual attractions, 
and dissolving bodies which are insoluble in 
common menstrua. We ought by no means 
to consider medicines inert in proportion as 
they are insoluble, for we have a proof to 
the contrary in calomel. Nor are we to con- 
sider those substances medicinally incompati- 
ble, which, if mixed out of the body, occasion 
a precipitate, or a change of color. What in- 
compatible, we would ask, destroys the effect of 
opium, strychnine, or cantharides ? 

Another consideration which has great weight 
with writers on chemistry and pharmacy, is the 
exactness and precision of the quantities em- 
ployed in their preparations. This circum- 
stance, although of great consequence in strict- 
ly chemical compounds, is less so in arbitrary 
mixtures ; and in the administration of simpler 
medicines its importance diminishes still fur- 
ther. Practical physicians know, that a degree 
of accuracy, approaching nearer than within « 
fifth or sixth part of the amount desired for 
pfoducing a given effect, is seldom attainable. 
Apothecaries divide their pills and powders by 
the eye, and patients take liquids by. drops and 



^ 



262 ON THE PHARMACOPCBIA 

spoonfuls. N^y, that physician must possess 
uncommon shrewdness, who, even after appor* 
tioning his dose by the most accurate weight 
and measure, can foretel with certainty how 
or when, how much or how often, it is going 
to operate. The stomachs of different patients, 
and those of the same patient at different times, 
vary more, if possible, than the samples of the 
same drug in commerce. 

On these accounts we feel but little concenu.^ 
for the changes which the convention havu "" 
thought proper to make in the character or — ^ 
strength of preparations and compositions, so^^ 
long as they do not exceed the limits above ■* 
mentioned. But in a few cases we observe =^ 
that the strength has been altered in the pro- — ^ 
portion of two to one, or vice versAj and oF ^ 
such changes we propose to take notice. The ' 
vinum antimonii, which in the old edition con- 
tained four grains to the fluid ounce, in this 
edition contains but two, and is therefore re- 
duced in strength one half. We object to this 
change, because the stimulating character of the 
menstruum is incompatible with the indications 
for which antimony is generally administered, 



OF THE UNITED STATES. 263 

and we apprehend that a glass or two of Tene- 
riffe wine would do no good to a man in apo- 
plexy or incipient fever. The wine, indeed, 
ought to bear as small a proportion as possible 
to the operative medicine, and if the London 
college is followed in lessening the proportion 
of antimony, it should also have been followed 
in diluting the wine largely with water. The 
vinegar and syrup of squill are increased to 
twice their former strength, a change in itself 
af no consequence, when the public shall have 
learned to regulate the dose. Liniment of am- 
monia is reduced to one quarter of its former 
strength. Can this preparation ever be too 
strong for the purposes to which it is applied ? 

In a work so generally uniform and consen- 
taneous in its parts as the American Pharma- 
copoeia, we would willingly have dispensed 
with such names as pulvis aromaticus and 
pilulse catharticae composites. These names 
designate nothing that is not common to a 
thousand other combinations. 

A few things are omitted in this edition, 
which we would have willingly seen retained ; 
bat we are not disposed to cavil on this ac- 



264 ON TUB PHARICACOPCEIA 



\ 



count, since in that instance, as well as in th^^ 
case of objectionable formulas, the evil ma^^ 
generally be remedied by extemporaneous pre——* 
scription. Every man has his particular tast^^^ 
and judgment, and de gustibus non disputan 
dam. In the wine of antimony, to which we 

have objected, the evil is remedied by extem -* 

poraneous solutions in water,, which are fa 
preferable to those in wine. Even though 
pharmacopceia should arrive at the highest anc 
most unquestioned point of excellence, stil^--^ 
physicians would suit themselves with formula^^* 
of their own, adapted to particular cases. W^^^ 
apprehend that most practitioners pass thei^^^' 
lives in ignorance of half the contents of phar- — ' '* 
maceutical works. For ourselves, not bein§ 
particularly given to hyper-practice, we should 
feel a strong sentiment of pity for the patients^^^ 
of that physician whose yearly rounds involved -^'^ 
the application of the whole phatmacopceia. 

To conclude, — having indulged somewhat ^^ 
freely in our remarks on the national work ^ 
produced by the convention at Washington, 
we proceed to make the amende honorable^ by 
declaring our conviction, that it is on the whole 



OF THE UNITED STATES. 265 

superior to any of the European pharmacopoeias 
with which we are acquainted ; that it is better 
suited to the wants of the American commu- 
nity than any work of the kind which has been 
published among us ; that it has emanated from 
a larger delegation, and has undergone a more 
rigorous supervision, than any similar produc- 
tion of the day; and that, therefore, it ought 
to become the standard of the United States. 
In conformity with the views expressed in the 
first part of this article, we also hope, that, to 
relieve the profession from the annoyance of 
incessant fluctuations, the contents of this book 
will be respected by all future conventions as 
something solid and permanent; and that if, 
as the edifice grows old, it shall be found to 
need repairs, enlargement, or modern decora- 
tions, still that its foundations may not be 
wantonly assailed, and that its walls may stand 
as a landmark and a barrier against the confu- 
sion of fluctuating language. 



OxN THE MUCUNA PRURIENS 



THE IRRITABILITY OF DIFFERENT TEXTURES. 



The DoHchos pruriens of Linneens, now call- 
ed Mucuna pruriens, and, in English, Cowhage, 
is a climbing plant of the West Indies, the pods 
or seed-vessels of which are covered with stiff, 
sharp bristles, or spiculce. I have examined 
these bristles in a microscope, and find them to 
be extremely acute, hollow, and apparently cov- 
ered on the outside with little warts or vesicles. 

It is well known that when these bristles are 
rubbed on the skin, they excite an intense and 
violent itching, which lasts for a considerable 
time* They have been sometimes indiscreetly 
used as a counter-irritant, applied to the skin, 
by spit^ading from four to six grains on lint, and 



ON THE MUCUNA PRURIENS. 267 

confining it with adhesive plaster. The result, 
within my observation, has been an exceedingly 
uncomfortable itching and burning of the part, 
which on the second day became universally 
red and inflamed. A copious eruption of papu- 
lae followed, which increased in size for a week, 
and at length terminated in pustules, which re- 
quired a second week to pass into scabs. In 
one patient two or three large prominences like 
boils, continued for ten days after the rest of the 
part was well. 

The irritation produced by cowhage appears 
to 'me greatly to exceed that which attends the 
application of flies or of tartar emetic. One 
patient, a woman, assured me she got no rest 
for two nights. On examining the skin, it was 
found in a state of great inflammation, exquisite 
tenderness, and stuck full of the spiculse. After 
attempting in vain to relieve the trouble by a 
poultice, recourse was had to a mixture of Plas- 
ter of. Paris and water, which was poured and 
suflered to harden upon the skin. \Vhen with- 
drawn from the skin, it extracted and brought 
with it the spicules, to the great relief of the 
patient. The same experiment, however, prov- 



268 ON THE MUCUNA PRURIENS. 

ed inapplicable to a man whose breast was 
covered with hairs, and did not admit of the 
process. 

Cowhage was introduced into practice, I be- 
lieve, by Dr. Chamberlain, who has published a 
small work upon it, strongly recommending it 
as a remedy for worms. Reasoning probably 
apriorij he supposed that a substance which 
occasions so much irritation to the human skin, 
would act in a similar manner upon the bodies 
of worms in the alimentary canal. Finding 
that when mixed with honey or molasses, it 
could be swallowed with impunity, this author, 
and subsequent writers of Dispensatories, have 
recommended its use as a remedy for worms, in 
the dose of from five to ten grains. "When 
strong cathartics have followed its employment, 
worms in some cases have been brought to light, 
but I apprehend not more frequently than in 
cases where no cowhage has been given. Many 
years ago, having occasion to doubt the anthel- 
mintic properties of this medicine, after it should 
have undergone the process of digestion in the 
stomach, I performed with it a number of expe* 
riments. A parcel of the spicules of full strength 



ON THE MUCUNA PRURIEN8. 269 

were soaked in blood-warm water for about ten 
minutes. On withdrawing them, they were 
found softened, apparently deprived of their 
venom, and wholly incapable of irritating the 
skin when rubbed upon it. Another portion 
was tied up in a muslin bag, and forced into the 
stomach of a cat At the end of ten minutes an 
emetic was administered, which brought up the 
bag with the spiculce so far digested that they 
could not be made to give the slightest irritation 
to the skin. I am therefore obliged to conclude 
that the vermifuge action attributed to cowhage 
was in reality due to the cathartics which fol- 
lowed its use. 

Within a few wieeks past,* I have noticed 
another curious property of the dolichos, that it 
stimulates the skin, but does not stimulate the 
mucous membrane. Applied to the hand, for 
example, it immediately causes violent itching ; 
but if rubbed on the inside of the lip, or tongue, 
it excites no sensation beyond the ordinary me- 
chanical stimulus. In like manner the effect on 
the outside and inside of the cheek are wholly 

* January, 1844. 



270 ON THE MUCUNA PRURIEN8. 

different It is this fact, probably, and not the 
sheathing quality of the mucilage or syrup in 
which it is taken, that enables patients at all 
times to swallow it with impunity, as a medi- 
cine. 

It is a field of interesting inquiry to ascertain 
how far particular morbid poisons and stimu- 
lants confine their action to particular textures. 
As far as my observation extends, the cutaneous 
poisons which produce eruptions on the skin 
independent of any acrimony, or general stim- 
ulating quality, such as the Rhus vernix, &c, 
for the most part confine their action to the true 
skin or dermoid texture, and do not inflame the 
mucous membrane, so that they have often been 
eaten with impunity. Were it otherwise, effects 
highly dangerous to life would occur from the 
inflammation of the trachea and other mucous 
passages, if an action should take place in them 
at all correspondent in violence to that which is 
seen upon the skin. But there is another class 
of poisons which ^fleets the mucous membrane, 
without incommoding the skin, at least by su- 
perficial contact. Such is the effluvium of 
roses and that of new hay, which always affect 



ON THE MUCUNA PRURIENS. 271 

certain persons with catarrhal symptoms. Such 
is also the poison of syphilis and that of gonor- 
rhcea, which are believed not to act through the 
cuticle, but which develop their activity as soon 
as they are brought in contact with a mucous 
surface. 

There are other poisons, which seem alike to 
influence the dermoid and mucous tissues. The 
sting of a bee or wasp immediately inflames the 
skin, and it is said to have occasioned death by 
suflbcation when applied to the fauces or throat. 
It is possible that the morbid poison of scarla- 
tina, and of some other diseases which aflect 
simultaneously the skin and mucous membrane, 
may possess the same universality of action. 



ON THE 



POISONOUS EFFECTS 



or 



THE AMERICAN PARTRIDGE, OR RUFFED GROUSE. 

The Tetrao umbellus of Linnaeus, variousl]^^ 
called Partridge in the northern and easteni^^^ 
States, Pheasant in Pennsylvania and the west^^^ 
ern States, and " Ruffed Grous" by Wilson, Nut — ^ 
tall, and Audubon, appears to inhabit the conti-^-**" 

nent from Hudson's Bay to the Gulf of Mexico,^ ^ 

and from the Atlantic to the Mississippi. It is— ^=^ 
a handsome bird of the Gallinaceous tribe, with 
mottled plumage, the tail 18-feathered, speckled, 
and barred with black, and with a black subter- 
minal band. The male has a ruff of broad 
black feathers on the sides of the neck, the 

lale a smaller ruff of a dusky brown. Its 



( 



OF THE UNITED STATES. 263 

md we apprehend that a glass or two of Tene- 
iffe wine would do no good to a man in apo- 
plexy or incipient fever. The wine, indeed, 
>iight to bear as small a proportion as possible 
3 the operative medicine, and if the London 
oUege is followed in lessening the proportion 
f antimony, it should also have been followed 
a diluting the wine largely with water. The 
inegar and syrup of squill are increased to 
wice their former strength, a change in itself 
i no consequence, when the public shall have 
samed to regulate the dose. Liniment of am- 
Qonia is reduced to one quarter of its former 
trength. Can this preparation ever be too 
trong for the purposes to which it is applied ? 

In a work so generally uniform and consen- 
ancQUs in its parts as the American Pharma- 
opcBia, we would willingly have dispensed 
\nth such names as pulvis aromaticus and 
(ilulce catharticae composites. These names 
[esignate nothing that is not common to a 
housand other combinations. 

A few things are omitted in this edition, 
nrhich we would have willingly seen retained ; 
>at we are not disposed to cavil on this ac- 



264 ON THE PHARACACOPCEIA 

count, since in that instance, as well as in the 
case of objectionable formulas, the evil may 
generally be renaedied by extemporaneous pre- 
scription. Every man has his particular taste 
and judgment, and de gustibus non disputon' 
dum. In the wine of antimony, to which we 
have objected, the evil is remedied by extem- 
poraneous solutions in water,, which are far 
preferable to those in wine. Even though a 
pharmacopoeia should arrive at the highest and 
most unquestioned point of excellence, still 
physicians would suit themselves with formohtf 
of their own, adapted to particular cases. We 
apprehend that most practitioners pass their 
lives in ignorance of half the contents of phar- 
maceutical works. For ourselves, not being 
particularly given to hyper-practice, we should 
feel a strong sentiment of pity for the patients 
of that physician whose yearly rounds involved 
the application of the whole pharmacopoeia. 

To conclude, — having indulged somewhat 
freely in our remarks on the national work 
produced by the convention at WashingtoHi 
we proceed to make the amende honorable^ b^ 
declaring our conviction, that it is on the whol^ 



OP THE UNITED STATES. 265 

superior to any of the European pharmacopoeias 
vith which we are acquainted ; that it is better 
suited to the wants of the American commu- 
lity than any work of the kind which has been 
>abiished among us ; that it has emanated from 
i larger delegation, and has undergone a more 
igorous supervision, than any similar produc- 
ion of the day; and that, therefore, it ought 
o become the standard of the United States. 
n conformity with the views expressed in the 
irst part of this article, we also hope, that, to 
elieve the profession from the annoyance of 
ncessant fluctuations, the contents of this book 
idll be respected by all future conventions as 
omething solid and permanent; and that if, 
s the edifice grows old, it shall be found to 
leed repairs, enlargement, or modern decora- 
ions, still that its foundations may not be 
i^antonly assailed, and that its walls may stand 
is a landmark and a barrier against the confu- 
sion of fluctuating language. 



OxN THE MUCUNA PRURIEN8: 



WITH RKMAKK8 ON 



THE IRRITABILITY OF DIFFERENT TEXTURES. 



The Dolichos pruriens of Linnaeus, now call- 
ed Mucuna pruriens, and, in English, CowhagCj 
is a climbing plant of the West Indies, the pods 
or seed-vessels of which are covered with stiff) 
sharp bristles, or spicules. I have examined 
these bristles in a microscope, and find them to 
be extremely acute, hollow, and apparently co^* 
ered on the outside with little warts or vesicle^ 

It is well known that when these bristles ar^ 
rubbed on the skin, they excite an intense au^ 
violent itching, which lasts for a considerable 
time. They have been sometimes indiscreetly 
used as a counter-irritant, applied to the skifj 
by spreading from four to six grains on lint, an^ 



ON THE MUCUNA PRURIENS. 267 

ining it with adhesive plaster. The result, 
lin my observation, has been an exceedingly 
3mfortable itching and burning of the part, 
ch on the second day became universally 
and inflamed. A copious eruption of papu- 
ollowed, which increased in size for a week, 

at length terminated in pustules, which re- 
ed a second week to pass into scabs. In 

patient two or three large prominences like 
s, continued for ten days after the rest of the 
; was well. 

'he irritation produced by cowhage appears 
ae greatly to exceed that which attends the 
lication of flies or of tartar emetic. One 
ent, a woman, assured me she got no rest 
two nights. On examining the skin, it was 
id in a state of great inflammation, exquisite 
lerness, and stuck full of the spiculae. After 
impting in vain to relieve the trouble by a 
Itice, recourse was had to a mixture of Plas- 
of. Paris and water, which was poured and 
fered to harden upon the skin. When with- 
wn from the skin, it extracted and brought 
th it the spiculsD, to the great relief of the 
tient The same experiment, however, prov- 



268 ON THE MUCUNA PRURIENS. 

ed inapplicable to a man whose breast was 
covered with hairs, and did not admit of the 
process. i^ 

Cowhage was introduced into practice, I be- ^ 

lieve, by Dr. Chamberlain, who has published a ^ 

small work upon it, strongly recommending it 
as a remedy for worms. Reasoning probably 
a priori, he supposed that a substance which 
occasions so much irritation to the human skin, 
would act in a similar manner upon the bodies . 

of worms in the alimentary canal. Finding ^^ 

that when mixed with honey or molasses, it 
could be swallowed with impunity, this author, 
and subsequent writers of Dispensatories, have 
recommended its use as a remedy for worms, in 
the dose of from five to ten grains. When 
strong cathartics have followed its employment, . 

worms in some cases have been brought to light? 
but I apprehend not more frequently than in 
cases where no cowhage has been given. Many 
years ago, having occasion to doubt the anthel- 
mintic properties of this medicine, after it should 
have undergone the process of digestion in the 
stomach, I performed with it a number of exp^* 
riments. A parcel of the spiculee of full strength 



\ 



11 



ON THE MUCUNA PRURIENS. 269 

vere soaked in blood-warm water for about ten 
ninutes. On withdrawing them, they were 
bund softened, apparently deprived of their 
'cnom, and wholly incapable of irritating the 
kin when rubbed upon it. Another portion 
7SLS tied up in a muslin bag, and forced into the 
tomach of a cat. At the end of ten minutes an 
metic was administered, which brought up the 
>ag with the spiculae so far digested that they 
ould not be made to give the slightest irritation 
3 the skin. I am therefore obliged to conclude 
hat the vermifuge action attributed to cowhage 
rsLS in reality due to the cathartics which fol- 
>wed its use. 

Within a few weeks past,* I have noticed 
nother curious property of the dolichos, that it 
bimulates the skin, but does not stimulate the 
lucous membrane. Applied to the hand, for 
sample, it immediately causes violent itching ; 
ut if rubbed on the inside of the lip, or tongue, 
1; excites no sensation beyond the ordinary me- 
hanical stimulus. In like manner the effect on 
he outside and inside of the cheek are wholly 

♦ January, 1844. 



270 ON THB Mucim^ FBimiBini, 

difE&rent It is this i^ei, probablyi uid iK>t tte 
< sh^ithing quality of the mndlage of synf in 
whicK it is taken, that miaUes patients it d 
times to swallow it with iiiipimityi«saiiiefi* 
cine. . . 

It is a field of intereisting inqoiiy to aseerhiA 
how far particular morbid poisons and sifam* 
lants confine their aetion to particular tcadoMk 
As far as my observation extends, the csaiattBem 
poisons which produce eruptions on tiis ri^ 
independent of any acrimony, or general stiflH 
ulating quality, such as the Ehus vemix,toi 
for the most part confine their action to the true 
skin or dermoid texture, and do not inflame the 
mucous membrane, so that they have often been 
eaten with impunity. Were it otherwise, effects 
highly dangerous to life would occur from the 
inflammation of the trachea and other mucous 
passages, if an action should take place in tbem 
at all correspondent in violence to that which is 
seen upon the skin. But there is another class 
of poisons which affects the mucous membrane, 
without incommoding the skin, at least by su- 
perficial contact. Such is the effluvium of 
roses and that of new hay, which always affect 



ON THE MUCUNA PRURIENS. 271 

in persons with catarrhal symptoms. Such 
o the poison of syphilis and that of gonor- 
, which are believed not to act through the 
[e, but which develop their activity as soon 
ley are brought in contact with a mucous 
ce« 

lere are other poisons, which seem alike to 
mce the dermoid and mucous tissues. The 

of a bee or wasp immediately inflames the 
and it is said to have occasioned death by 
cation when applied to the fauces or throat, 
possible that the morbid poison of scarla- 

and of some other diseases which affect 
Itaneously the skin and mucous membrane, 
possess the same universality of action. 



ON THE 



POISONOUS EFFECTS 



THE AMERICAN PARTRIDGE, OR RUFPED GROUSE. 

The Tetrao umbellus of Linnaeus, variously 
called Partridge in the northern and eastern 
States, Pheasant in Pennsylvania and the west- 
ern States, and " Ruffed Grous" by Wilson, Nut- 
tall, and Audubon, appears to inhabit the conti- 
nent from Hudson's Bay to the Gulf of Mexico, 
and from the Atlantic to the Mississippi. It is 
a handsome bird of the Gallinaceous tribe, with 
mottled plumage, the tail 18-feathered, speckled, 
and barred with black, and with a black subter- 
minal band. The male has a ruff of broad 
black feathers on the sides of the neck, the 
female a smaller ruff of a dusky brown. Its 



THE AMERICAN PARTRIDGE. 273 

favorite resorts are mountainons regions covered 
with evergreen trees, and in more cultivated 
countries it often frequents apple-trees, which 
are secluded or concealed by woods, having el 
fondness for the buds of this tree. It is well 
known to residents in the interior, by the drum- 
ming noise which in the pairing season it malces 
with its wings, and also by the stratagem with 
which the mother protects her young by an illu- 
sive demonstration of surrendering herself in 
their place. 

The partridge is quite common in the eastern 
States, and constitutes one of the most frequent 
kinds of game in our markets. The flesh is 
much prized for the delicacy of its flavor, and is 
in its greatest perfection in September and Oc- 
tober. It feeds in summer on wild berries, and 
at other seasons on the leaves, buds, and seeds 
of various plants. 

It is generally known, that although vast 
numbers of these birds are every year consumed 
with impunity, yet instances now and then hap* 
pen of persons being apparently poisoned or 
made sick with alarming symptoms, soon after 
swallowing their flesh. The following cases are 



274 



ON THE POISONOUS EFFECTS OF 



selected from among a larger number, whicCL h 
have been observed by myself or my medica^^l 
friends, and of which a part are in the record^Hs 
of the Society of Medical Improvement. 

Case I. — A gentleman of this city havii^ g 
dined at Worcester in part upon partridge, to(^ Jc 
the cars for Boston half an hour afterwar^3 
In an hour after entering, he was taken wifc 1 
sensations like those of sea sickness, accomp^3i- 
nied with dizziness and great prostration ^^f 
strength. With difficulty he got his head om:xt 
and vomited from the window of the car. l^e 
continued faint, cold, dizzy, and unable to ^^^ 
up, with ringing in the ears and imperfect visio:^* 
He was conveyed to his house in a sinking arm ^ 
nearly insensible state. When I first saw hin^) 
he was cold and moist, with a slow intermittem^^ 
and very feeble pulse, difficult comprehensio *^» 
and sluggish utterance. He had vomited aga:^^^ 
with some relief. His vision was partially r ^" 
covered. Stimulants had been given him, wi^J^" 
hot applications and frictions to the surfac^^^^' 
under which he gradually recovered. 



THE AMERICAN PARTRIDGE. 275 

Case IL — A lady of delicate health took at 
dinner a small piece of the breast and leg of a 
partridge. Two hours afterward she became 
suddenly very faint, and her physician (Dr. Put- 
nam) was called. She was found by him in a 
sitting posture on the bed, supported by two 
assistants, with the body bent forward. The 
surface was generally cold, countenance pale 
and sunken, and voice feeble. There was 
slight, frequent convulsive action of the muscles. 
The pupils were dilated, with loss of vision. 
Pulse irregular, feeble, at times nearly imper- 
ceptible. There was drowsiness approaching 
to insensibility, nausea and vomiting. Spiritu- 
ous stimulants were given and ipecacuanha, 
with warmth, friction and sinapisms externally. 
Soon after free vomiting took place there was 
evident amendment The sensibility returned, 
questions were comprehended, but the answers 
were slow and laborious. In the course of two 
or three hours vision was restored with contrac- 
tion of the pupils and intolerance of light, with 
a remaining sense of numbness and uneasiness 
in the head. 



ojn the mucuna pruriens*. 



WITH RWMABgfl ON 



THE IRRITABILITY OF DIFFERENT TEXTURES ^ 

The Dolichos pruriens of Linnaeus, now c^^' 
ed Mucuna pruriens, and, in English, Cowha^S^> 
is a climbing plant of the West Indies, the pC^^^ 
or seed-vessels of which are covered with st^^**' 
sharp bristles, or spiculae. I have examia ^" 
these bristles in a microscope, and find them ^ 
be extremely acute, hollow, and apparently cc^ ^' 
ered on the outside with little warts or vesicl^^^ 

It is well known that when these bristles a-^^ 
rubbed on the skin, they excite an intense ajT^^ 
violent itching, which lasts for a considerah^ ^^ 
time. They have been sometimes indiscreeC^J 
used as a counter-irritant, applied to the ski -^' 
by spreading from four to six grains on lint, ai^^- 



ON THE MUCUNA PRURIENS. 267 

confining it with adhesive plaster. The result, 
within my observation, has been an exceedingly 
oncomfortabie itching and burning of the part, 
which on the second day became universally 
red and inflamed. A copious eruption of papu- 
la followed, which increased in size for a week, 
3ind at length terminated in pustules, which re- 
g[uireda second week to pass into scabs. In 
>ne patient two or three large prominences like 
>oils, continued for ten days after the rest of the 
part was well. 

The irritation produced by cowhage appears 
to "me greatly to exceed that which attends the 
Bipplication of flies or of tartar emetic. One 
patient, a woman, assured me she got no rest 
for two nights. On examining the skin, it was 
found in a state of great inflammation, exquisite 
tenderness, and stuck full of the spiculee. After 
attempting in vain to relieve the trouble by a 
poultice, recourse was had to a mixture of Plas- 
ter of. Paris and water, which was poured and 
suffered to harden upon the skin. When with- 
drawn from the skin, it extracted and brought 
"With it the spicule, to the great relief of the 
patient. The same experiment, however, prov- 



376 ON THE POISONOUS EFFECTS OF 

Case III. — A man aged sixty, who had a^EH- 
ways been healthy, but within a few month^^s 
troubled with shortness of breath, which hi^Ss 
physician attributed to some affection of tl^HKe 
heart, ate the white meat of a partridge, avoi(z3- 
ing the dark meat and the parts contiguous tzz o 
it About an hour afterwards he went to churc'Xn, 
where he was shortly taken with a sensation ^^^f 
distress at the stomach, which he referred fc^ 
the disagreement of his food. He endeavors ^ 
to resist this annoyance, and kept his seat fc:=^^ 
some time, but at length his sight totally 1^ ^* 
him, he became faint, and fell. He was carrier ^ 
out of church, and laid on his back in the op^^- ^ 
air. At this time there was no pulse, and tt ^ 
respiration was hardly perceptible. Thes -^ 
symptoms were at first attributed by thos^^* 
around to the suspected disease of the heari^^' 
but in the course of ten minutes he began tc 
revive. The first word he uttered was 'poison 
ed,' and the second, ' the partridge.* He soor 
began to revive, sat up, got upon his feet with 
assistance, but had lost all power over his legs^^^' 
and was unable to stand. He was now pu^ — ^ 
into a carriage, some pressure was made upo^^*' 



/ 



THE AMERICAN PARTRIDGE. 277 

the stomachi and he began to vomit. Ipecac 
and warm water were given him until the 
stomach was fully evacuated. He remained 
somewhat delirious for a few hours, but on the 
following day was restored to his customary 
health. 

Case IV. — A gentleman, twenty-six years of 
age, dined at 5 P. M. on soup, boiled tongue and 
potatoes, and ate the leg and part of the breast 
of a partridge. He afterwards went to a club- 
room, and remained till 8. On going out at 
this time he became chilly, and felt a sharp 
pain through the temples. He repaired to a 
shop for some soda-water, and while standing 
there was aflFected with vertigo and a * trance- 
like' feeling. This was followed by ringing in 
the ears, and a remarkable sense of coldness, 
mostly in the back of the neck and shoulders. 
He was unable to get warm at the fire, and the 
sensation given to bystanders by his head was 
compared to that of the contact of a stone jar. 
He had taken hot spirit and water, and was 
sitting up when seen by Dr. Holmes at 9 o'clock. 
At this time the voice and expression were 



\ 



278 ON THE POISONOUS EFFECTS OF 

natural, mind a little excited, vision dim at 
times and once or twice quite lost, pupils widely^ 
dilated and equal, contracting but slightly on 
the approach of a light, hands rather cold, pulse 
76, regular, small but not thready, no nausea nor "* 
vomiting. Took wine of ipecac, and threw ofE" s 
freely portions of food. In the course of halir-^ 
an hour was thoroughly relieved, but was Ian— — 
gu^id and costive next day. 

Two or three other persons, as it appeared^^=i 
had partaken of the same partridge witbout^^ 
obvious inconvenience. 

Case V. — A gentleman, aged seventy-four,^^ 
of full habit and subject to gout, ate at breakfasl^^ 
the black meat of one partridge. In an hour or* ** 
two he went to church, where he soon became 
sick, faint and dizzy. On being carried home 
he was found in a state approaching that of 
collapse, pale, livid, cold, nearly pulseless, and 
without vision. His appearance was that of a 
dying man with glazed eyes and gasping for' 
breath. Had repeated nausea, but vomited^ 
fluids only. Took stimulants, principally hot 
gin and water, and gradually recovered, after^ 



niK AMERICAN PARTRIDGE. 279 

passing a restless night with much thirst. It 
was remarked that others of the family ate the 
white meat of the same bird without any disa- 
greeable consequences. 

Case VI. — A female, who had eaten at 12 
o'clock of the white and black meat of a par- 
tridge, in half an hour was taken with pain in 
the chest and throat, nausea, weakness and loss 
of sight. Was seen by her physician at 4 P. M. 
Her pulse was 54, and hardly perceptible. After 
taking brandy and water and half a drachm of 
ipecac, her pulse improved in strength, but was 
still 54 only. Her mind remained clear, and 
the most remarkable symptoms were the blind- 
ness and slow and feeble pulse» 

Case VII. — An elderly gentleman, of full 
habit, breakfasted in part on a partridge. In 
two hours he was seized with dizziness, partial 
loss of consciousness, and violent pain extend- 
ing through the abdomen to the back. When 
visited by Dr. H. J. Bigelow, he was found on 
his hand^ and knees, cold, faint, partly insensi- 
ble and nearly pulseless. The pain having sub- 



280 ON THE POISONOUS EFFECTS OF 

sided, returned at intervals, causing him to calL 



often to have his back rubbed. After an emetic= 
he was much relieved, and rallied slowly in 
the course of the afternoon. 

Case VIII. — For this and the two following^ 
I am indebted to Pr. Morrill Wynaan. 

A very athletic and active man, aged fifty, at 
times making very great and long-continuedi 
exertion and eating freely, February 14, 1849^ 
took supper at 7 P. M. ; ate two roasted par- 
tridges, with ale and other liquors. At 8 o'clocli 
felt somewhat heavy, and thinking he had eater 
too much supper, proposed to go to the bowling^S 
alley for exercise. In a few minutes perceived 
that the lights in the room had a blue tinge, the 

fire also ; asked if any new kind of burning^ 

fluid had been used, and immediately fell, with 
loss of consciousness. Just previously to the=^ 
loss of consciousness, had pain in the back of 
the neck, extending down along the spine and 
into the arm. In ten or fifteen minutes partially 
recovered, — then again unconscious ; muscles 
of limbs completely relaxed ; face very pale ; 
respiration four to six times per minute ; pulse 




I 



TUB AMERICAN PARTRIDGE. 281 

18 to 22 ; hands and feet cold and moist ; 
groaned frequently; vomited freely and spon- 
taneously, and afterwards under the influence 
of mustard flour mixed with warm water. Warm 
blankets and bottles of hot water were applied 
to the epigastrium and limbs, and in the course 
of two hours he had recovered his consciousness 
and drank warm tea. Slept well during the 
night In the morning was quite welL 

Case IX.— ^ Same individual. February 23, 
1850, went into the country in the morning and 
rode till 3 o'clock, P. M. ; then sat down in the 
open air and ate a part of a partridge, but it 
was so bitter that the remainder was thrown 
away; drank a wine-glass of brandy. Took 
railroad train, and on leaving it in thirty-five 
minutes walked from fifteen to twenty min- 
utes, when (about one hour after eating the 
partridge,) had pain in the back of the neck and 
Ijimbs. Passed a house, and observed that the 
lights appeared blue, and immediately suspect- 
ed the partridge of being the cause of his trou- 
bles. Soon after, found himself at the bottom 
of a steep declivity, having lost his conscious- 



282 ON THE POISONOUS EFFECTS OF 

ness and rolled down a bank. Got up, and 
walked to a house; again noticed the blue 
lights. In attempting to take a glass of cold 
water again lost his consciousness and fell ; was 
carried home, and after taking mustard flour, 
vomited and was soon relieved. Before vomit- 
ing, respiration very slow and not more than half 
the usual number of inspirations. Pulse 42 per 
minute ; hands and feet cold and the face pale. 
During the periods of loss of consciousness, 
which did not continue more than five minutes 
at a time, the limbs were quite powerless. The 
recovery was sudden, and the action energetic ; 
speech impeded, apparently from want of mus- 
cular power. Time elapsed between first symp- 
toms and relief by vomiting, from an hour and 
a half to two hours. 

Case X. — Mrs. W., aged forty-five, ate for 
dinner, two days before the date of the last case, 
a part of a roasted partridge, bought at the 
same time with that used by her husband. 
This, also, was extremely bitter, and only a 
small quantity eaten. After dinner walked a 
mile to a conservatory ; when near the conserv- 



THE AMERICAN PARTRIDGE. 283 

atory felt weak ; pain in both back of neck and 
limbs. Felt faint in the conservatory, and 
obliged to return to the open air ; yras nausea- 
ted, but did not vomit. Immediately walked 
towards home ; found her limbs unsteady, obliged 
to run and then stop and support herself by the 
fence ; was compelled to lie down, but did not 
lose consciousness ; was carried home. The pain 
in the back of the; neck and limbs continued till 
9 o'clock, when she went to bed. Had occasion- 
ally some difficulty of breathing, a catching of 
the breath. In the morning was quite well. 

Neither of these individuals have eaten par- 
tridges since. 

The principal and most characteristic symp- 
toms were loss of consciousness ; relaxation of 
the muscles, and in one instance of the sphinc- 
ters ; paleness ; cold feet and hands ; slow and 
infrequent respiration, and slow and infrequent 
but regular pulse. The act of vomiting was 
followed by almost immediate relief. 

To these cases may be added a number more, 
the outlines of which have been communicated 
by different medical friends. 



S84 ON THE POISONOUS EFFECTS OF 

From a general analysis of the symptoms 
produced, it appears that under certain circum- 
stances the flesh of the partridge acts as a direct 
sedative poisoui impairing the functions of the 
brain, and, in connection, those of the digestive 
and circulating systems. The cerebral symp- 
toms, in a majority of cases, have been vertigo, 
loss of sight, tinitus aurium, and in bad cases 
general loss of the power of sensation and vol- 
untary motion. Respiration has been slow, 
sometimes to a great degree. In the circulating 
system there has been syncope, feeble and some- 
times irregular action of the heart ; weak, slow, 
and sometimes imperceptible pulse; cold sur* 
face, and pale or livid complexion. In the 
digestive system there is oppression, nausea 
with tendency to vomit, and in many cases pain 
in the abdomen extending through to the back. 
In more rare cases pain has been felt in the 
head and limbs. 

The foregoing morbid symptoms have mostly 
appeared within two or three hours after taking 
the food. But instances have occurred in which 
persons have been taken before leaving the table. 

The poison of the partridge has never, to my 



THE AMERICAN PARTRIDGE. 285 

knowledge, proved fatal. The remedies usually 
and properly resorted to, are a prompt emetic, 
accompanied or followed by stimulants, if the 
prostration is urgent. Free spontaneous vomit- 
ing not unfrequently removes the difficulty be- 
fore the physician arrives. Acrid stimulants, 
such as a teaspoonful of mustard, may serve the 
double purpose of a quick emetic and an in- 
citant to the depressed vital powers. Spirits, 
and other diffusible stimulants, are indicated by 
the sinking condition of the patient, but the 
anxiety of friends often leads to their excessive 
administration, for which the patient pays by a 
prolonged continuance of his narcotism. Fric- 
tion and external warmth are indicated and 
generally desired by the patient. 

The flesh of the partridge is justly esteemed 
as a great delicacy, and is abundantly sold in 
the markets of this and many other cities. 
Audubon says of it : * In my humble opinion it 
far surpasses as an article of food any land bird 
we have in the United States, except the wild 
turkey.' It is in its best condition in the fall of 
the year, and continues to be common through- 



286 ON THE POISONOUS EFFECTS OF 

out the winter. We have hardly any species of 
game which is sought for with more avidity, or 
consumed, in proportion to its size, in greater 
numbers. As a general rule, it is, and may be 
taken with perfect impunity. 

The fact that the meat of the partridge occa- 
sionally proves poisonous, has given rise to 
much speculation in regard to the cause. The 
point most generally admitted respecting it, is, 
that its bad effects chiefly, if not always, take 
place in winter, when the ground is covered 
with snow. This circumstance has given rise 
to a popular belief that the noxious quality in 
the meat of the bird is attributable to some poi- 
sonous food on which, in winter, it is driven to 
subsist. And a prevalent suspicion has been 
fixed upon the mountain laurel (Kalmia latifolia)^ 
on the buds and leaves of which the partridge 
has been supposed to feed in cold weather. 
But this suspicion appears to be not well found- 
ed, since I have observed in experiments made 
purposely, that the leaves of the kalmia are not 
particularly poisonous, when taken into the 
human stomach in any quantity which the bird 
would be likely to devour ; and the crops, when 



THE AMERICAN PARTRIDGE. 287 

examined in winter, are found to contain leaves 
and fragments of most of the wild evergreen 
plants which are in verdure at that time. I 
have found among other things portions of 
leaves of Pyrola, Gaultheria, Srailax, Coptis, 
Mitchella — also buds of Azalea, alder and apple 
tree, which latter appears to be a favorite food 
with the partridge. 

It is, furthermore, not very probable that the 
common process of putrid decomposition is con- 
cerned in producing the noxious effects in ques- 
tion, for this circumstance would be generally 
detected by the taste, and the incipient putres- 
cency so often recognized in game is usually 
corrected by the antiseptic effect of the gastric 
juice. 

More probable solutions of the difficulty are, 
1. That the bird is affected with some disease 
at the time of its death. 2. That some slow 
chemical change, not putrefactive, may take 
place when the flesh is long kept in cold weath- 
er, as observed by my friend Dr. Cabot. 3. That 
the idiosyncrasy of individuals renders some 
persons intolerant of this species of food. This 
latter supposition is sustained by the facts, that 



288 THE AMERICAN PARTRtDOK. 

the same person has sometimes been affected 
twice, — that a majority of persons, partaking of 
the same partridge, escape unharmed, when 
others are poisoned, — and that individuals are 
found who cannot eat lobster, mackerel and 
certain other kinds of food without suffering 
symptoms approaching in character to those 
already described. 



ON COFFEE AND TEA; 

AND THEIR MEDICINAL EFFECTS. 

The articles Coffee and Tea have been so 
long and so generally introduced as luxuries of 
the table, that they are now viewed by i!he 
world as materials of diet and nutrition, and 
not in their proper light, as substances incapa- 
ble of nourishing the body in any considerable 
degree, and depending for their value on an 
eflfect which is simply medicinal. If any one 
doubts whether they should be referred to the 
class of aliments, or to that of medicines, let 
him try the experiment of supporting life upon 
coffee or tea alone, and he would probably find 
that his term would not be much prolonged 
by such an expedient. Yet, when taken in 
combination with nutritious food, both these 
articles exert a salutary and useful influence 
upon digestion and health. The experience of 
10 



290 ON COFFEE AND TEA. 

all civilized nations has shown them to be 
innocent, when used at proper times and in 
moderate quantities, while, like all other medi- 
cinal substances, they are capable of abuse, if 
taken under improper circumstances or to an 
excessive degree. 

As these two substances have a close af&nity 
to each other, possessing properties not known 
to exist in any other plant, they are properly 
associated with each other as a class under the 
name of anthppnotics. Should any plant be here- 
after found to possess qualities similar to those 
of coffee and tea, it would doubtless acquire an 
immediate value, and perhaps be in the same 
request as these imported articles. The subject 
is an interesting one for future inquiry, and al- 
ready an identity in the active alkaloid principle 
has been asserted for some species of Ilex and 
Paullinia, consumed by the inhabitants of South 
America. 

The prevailing fondness for coffee and tea is 
probably an acquired taste, like that for tobacco 
and alcohol. The flavor of both these articles 
in their crude state is disagreeable to most 
persons not already initiated in their use. But 



ON COFFEE AND TEA. 291 

the discovery in modern times of their second- 
ary effects, and the agreeable influence which 
they exert on the brain and nervous system, 
has created for them a general demand and 
consumption throughout the world. 

COFFEE. 

Coffee is the product of the Coffcea Arabica^ 
a small tree which grows native in Arabia and 
several warm countries of the old continent, 
and is now cultivated extensively in the West 
Indies and tropical parts of the continent of 
America. The fruit of this tree is a roundish 
oblong berry, containing two seeds, the form 
and appearance of which are sufficiently familiar, 
constituting the common coffee which is brought 
to this country. 

The use of coffee was unknown to the Greeks 
and Romans, and does not appear to have been 
known in the Asiatic couptries as late as the 
time of the Crusades in the thirteenth century, 
although its first introduction into Europe was 
firom Arabia. It seems to have been earliest in 
use in Ethiopia, where it has been drunk by 
the natives for a great length of time. Mr. 



292 ON COFFEE AND TEA* 

Bruce, in his Travels ia Abyssinia states, that 
the Galte, a wandering nation of Africa, in 
their incursions on Abyssinia, being obliged to 
traverse immense deserts, and wishing to be 
encumbered with as little baggage as possible, 
take with them a mixture of coffee and butter 
rolled up into balls, and carried in a leathern 
bag. One of these, about the size of a billiard 
ball, keeps them, they say, in strength and 
spirits during a day's fatigue. Coffee was in- 
troduced into Meeca, Medina and Cairo about 
the middle of the fifteenth century, and two 
coffee-houses were opened at Constantinople 
in 1554. Both at Cairo and in Turkey it had 
to encounter political and religious opposition ; 
the dervises affirmed that roasted coffee was 
nothing but a coal^ and that the eating of coals 
was forbidden by the laws of their prophet. 
So that the coffee-houses were obliged to be 
shut up until ' a more sensible mufti ' succeed- 
ed in convincing the people th^t roasted coffee 
was not a coal, upon which they were again 
opened. In later years the use of coffee be- 
came extremely prevalent throughout the east 
Houses for selling it were established in all 



ON COFFEE AND TEA. 293 

parts of the Turkish empire ; it was introduced 
into private families, and the refusal of a 
husband to supply his wife with coffee was 
reckoned among the legal causes of a di- 
vorce. 

In Europe coffee was introduced into France 
and England about a century and a half ago. 
So rapid was the progress of a taste for it after 
it became known, that in eight years from its 
introduction, it had become in England a subject 
of public revenue. 

Coffee has seldom been used in its raw 
state, except sometimes as a fanciful addition 
to certain liqueurs and ices. A decoction of raw 
coffee is disagreeable to the taste, but appears 
to possess properties analogous to those which 
it exhibits after being roasted. The roasting 
of coffee improves its flavor, and occasions 
considerable changes in its chemical constitu- 
tion, without impairing its stimulant or medi- 
cinal activity. A peculiar alkaloid, called caf^ 
feine, is detected in both raw and roasted coffee. 
It is considered by chemists to be identical 
with theincy found in tea and in a few other 
vegetables. An aromatic oil, which has been 



394 ON COFFEB AND TEA. 

called caffeone^ is produced during the process 
of roasting. 

During the extensive trial which has beef 
made all over the world, as to the effect of 
coffee upon the health, no small diversity of 
opinion has existed in regard to its specific 
powers. Of the properties ascribed to it, two 
seem better established than any others. These 
are its property of assisting digestion, and that 
of obviating drowsiness. Coffee, when taken 
into the stomach, usually creates a pleasing 
sense of vigor in that organ, it moderates ali- 
mentary fermentation, takes off the feeling of 
distension and heaviness occasioned by over- 
eating, counteracts in some degree the fumes 
of wine, and produces a lightness and hila^ 
ity of mind, more moderate but more per- 
manent than that occasioned by vinous or 
spirituous liquors. The custom derived from 
the French of drinking coffee after dinner, is 
beneficial, and powerfully promotes the process 
of digestion. It is known to epicures of most 
countries, that a cup of strong coffee, at the 
end of some hours spent at the table, enables 
them to continue their functions, both of body 



ON COFFEE AND TEA. 



295 



^^d mind, to a greater extent than would have 
^^^fi done under any other assistance. 
^PPft is well known that coffee is strongly pro- 
motive of watchfulness, and enables us to resist 
for a long time the approaches of sleep. Stu- 
dents, whose lucubrations occupy a consider- 
able portion of the night, find a great increase 
of the vigilance and vigor of their faculties, 
derived from the use of both coffee and tea. 
In fact, the long habit of drinking these articles 
renders us so dependent on them, for the power 
of keeping the mind awake and active, that a 
change from them to any other kind of diet 
creates in most persons, at least for a time, a 
drowsiness and dulness of intellect Hence it 
is common to hear milk and chocolate accused 
of creating sleepiness, an effect which arises, not 
from any real soporific influence in those arti- 
cles, bat from the change of diet, and the want 
of the customary stimulus of coffee and tea. 
The Turks and Arabians consume large quan- 
tities of coffee, because it acts as an antidote 
to the stupefying effect of opium, to the abuse 
of which those nations are generally addicted. 
It has already been mentioned, and is a fact 






296 ON COFFEE AND TEA. 

which every practitioner should remember, thj 
perhaps no antidotal substance exerts so 
erful an agency in counteracting the effect 
only of opium, but of alcohol and the whole 
tribe of narcotics as a seasonable draught of 
strong coffee. 

Many complaints have been ascribed to the 
frequent and excessive use of coffee, such 
as tremors, headache, vertigo, and some more 
serious disorders. These complaints are most 
apt to appear when coffee has been taken 
alone, without a sufficient quantity of nourish- 
ment accompanying it. It is common for 
physicians, in the course of practice, to hear 
complaints of a sinking at the stomach, uni« 
versal trembling of the limbs, and a loss of 
muscular power, coming on at eleven or twelve 
in the morning, and incapacitating the patient 
for business. These complaints I have, in more 
than half the instances which have come under 
my notice, been able to trace to a cup or two 
of strong coffee, or perhaps tea, taken for break- 
fast without a particle of nourishment, or at 
least without a sufficient quantity to support 
the system, during and after the stimulant ope- 



/ ON COFFEE AND TEA. 297 

ration of these active liquids. I have generally 
found these complaints to be most effectually- 
relieved by the simple remedy of eating, and 
cured either by increasing the quantity and 
quality of nourishment taken in the morning, or 
by exchanging the coffee for cocoa, chocolate or 
milk. 

TEA. 

The tea tree, called by Linnaeus Thea, is a 
native of Japan, China, Tonquin, and Assam. 
LinnsDus believed that there were two distinct 
species of this genus, producing the green tea 
and the black, to which he has given the names 
of Thea viridis and Thea bohea^ and distin- 
guishes them by the number of petals in their 
flowers, the one having six petals, the other 
nine. But subsequent observers have found the 
number of these organs to be uncertain, vary- 
ing from three to nine ; and travellers in China 
and Japan, as well as various distinguished 
botanists, have arrived at the opinion, that the 
different kinds of tea brought from those coun- 
tries are the product of a single species, subject 
only to varieties from the influence of soil, cli- 



298 ON COFFEE AND TEA. \y 

1.- 

mate, time of gathering, and mode of prepara- 
tion. 

The tea plant is a small evergreen tree or 
shmb, of the height of six or eight feet It 
grows in the valleys, and on the sloping sides 
of mountains, with a southern exposure. In 
Japan it is planted around the borders of fields 
without regard to the kind of soil, while in 
China, where it is an important article of com- 
merce, whole fields are covered with it, and 
cultivated with the greatest care.* 

* The origin of the employment of tea as a beverage amongst 
the Chinese, is wrapped in the obscurity which generally be- 
longs to ancient usages ; and a fabulous tale is narrated, as to 
its introduction, which has had credence even amongst the 
better informed inhabitants of the empire, whilst, as is usual 
with fables, it has been imagined to have some allegorical 
allusion, which, if explained, would satisfy the lover of anti- 
quarian lore. The tale is thus related by one of the compilers 
of a history of China : — 

' Darma, a very religious prince, and third son of an Indian 
king, named Rosjusvo, is said to have landed in China, in the 
year 510 of the Christian era. He employed all his care and 
thought to diffuse throughout the country a knowledge of God 
and religion ; and, being desirous to excite men by his exam- 
ple, imposed on himself privations and mortifications of every 
kind, living in the open air, and devoting the days and nights 



ON COFPEB AND TEA. 299 

When the plants have attained their third 
year, the collection of the leaves is commenced. 
It is repeated every year until the trees are 
seven or eight years old, after which they are 
cut down, that they may shoot up afresh from 
the roots, a process which increases the quan* 
tity of leaves. 

The leaves are carefully picked oS', one by 
one. In Japan, the best kind, called imperial 
tea, is collected at the end of February, or the 
beginning of March, before the leaves are fully 
unfolded. This tea is scarce and dear, and is 

to prayer and contemplation. After several years, howeYer, 
being worn out with fatigue, he fell asleep against his will ; 
and, that he might faithfully obsenre his oath, which he thought 
he had violated, he cut off his eyelids, and threw them on the 
ground. Next day, having returned to the same spot, he found 
them changed into a shrub which the earth had never before 
produced. Having eaten some of the leaves of it, he found his 
spirits exhilarated and his former vigor restored. He recom- 
mended this aliment to his disciples and followers. The repu- 
tation of tea increased, and after that time it continued to be 
fsnerally used. Ksunpfer, in his Amanitates Exotica, gives 
the lift with a portrait of this saint, so celebrated in China 
and Japan. There is seen at the feet of Darma a reed, which 
indicates that he had traversed the seas and rivers.* — Sigmoni 



292 ON COFFEE AND TEA. 

Bruce, in his Travels ia Abyssinia states, that 
the Galte, a wandering nation of Africa, in 
their incursions on Abyssinia, being obliged to 
traverse immense deserts, and wishing to be 
encumbered with as little baggage as possible, 
take with them a mixture of coffee and butter 
rolled up into balls, and carried in a leathern 
bag. One of these, about the size of a billiard 
ball, keeps them, they say, in strength and 
spirits during a day's fatigue. Coffee was in- 
troduced into Meeca, Medina and Cairo about 
the middle of the fifteenth century, and two 
coffee-houses were opened at Constantinople 
in 1554. Both at Cairo and in Turkey it had 
to encounter political and religious opposition ; 
the dervises affirmed that roasted coffee was 
nothing but a coal^ and that the eating of coals 
was forbidden by the laws of their prophet 
So that the coffee-houses were obliged to be 
shut up until ' a more sensible mufti ' succeed- 
ed in convincing the people th^t roasted coffee 
was not a coal, upon which they were again 
opened. In later years the use of coffee be- 
came extremely prevalent throughout the east 
Houses for selling it were established in all 



ON COFFEE AND TEA. 293 

parts of the Turkish empire ; it was introduced 
into private families, and the refusal of a 
liusband to supply his wife with coffee was 
reckoned among the legal causes of a di- 
vorce. 

In Europe coffee was introduced into France 
and England about a century and a half ago. 
So rapid was the progress of a taste for it after 
it became known, that in eight years from its 
introduction, it had become in England a subject 
of public revenue. 

Coffee has seldom been used in its raw 
state, except sometimes as a fanciful addition 
to certain liqueurs and ices. A decoction of raw 
coffee is disagreeable to the taste, but appears 
to possess properties analogous to those which 
it exhibits after being roasted. The roasting 
of coffee improves its flavor, and occasions 
considerable changes in its chemical constitu- 
tion, without impairing its stimulant or medi- 
cinal activity. A peculiar alkaloid, called caf' 
feine, is detected in both raw and roasted coffee. 
It is considered by chemists to be identiccd 
with theiney found in tea and in a few other 
vegetables. An aromatic oil, which has been 



302 ON COFFEE AND TEA. ' 

the cooling, the better they are rolled, and on 
this account the workmen agitate the air with a 
kind of fan But, in spite of this precaution, a 
great number of the leaves unroll themselves, 
and are obliged to be separated and roasted, 
and rolled several successive times before they 
are in order to be packed. 

In order that the tea should keep well, it 
must be inclosed in vessels which are air-tight 
Keempfer assures us that the tea brought into 
Europe is always injured in quality, and never 
retains the fine flavor and delicate perfume 
which it has in its own country. The Japanese 
inclose their tea in vessels of tin, which, if large, 
are placed in savin boxes having their cracks 
closed with paper within and without. The tea 
imported to this country from China, it is well 
known, comes in tight wooden chests, lined 
with sheet lead hermetically soldered. It is 
packed in these chests by the Chinese, by 
stamping it down with their bare feet. 

Some writers have asserted that the tea is 
roasted upon plates of copper, and that its color 
is owing to verdigris, with which it thus be- 



ON COFFEE AND TEA. 303 

comes impregnated. But those travellers who 
are most entitled to credit, affirm that the plates 
are, without exception of iron; and Dr. Lettson, 
after a great number of experiments made with 
chemical tests, never detected any trace of cop- 
pey so that this suspicion appears to be void of 
foundation. 

Among the Chinese tea is drunk in a variety 
of ways. Some use it as we do, in the form of 
an infusion ; others take it in the form of fine 
powder mixed with boiling water. The com- 
mon or laboring people are said to use it in 
decoction, several handfuls of the ordinary kinds 
of tea being boiled in a kettle of water until the 
strength is extracted. This is taken by them as 
their common drink for assuaging thirst, and 
diluting ^neals. 

Tea was first introduced into Europe by the 
Dutch, before the middle of the seventeenth 
century, and several physicians of eminence, 
either from conviction of its utility, or per- 
haps for the more substantial reason of a 
pecuniary reward, published warm eulogies in 
its favor. From this time its adoption was 
rapid in all the countries of Europe, and it is 



)4 ON COFFEE AND TEA. 

iOW a common article of diet with both rich 
and poor.* 

* Nicolaus Tulpius was about the first medical man who 
wrote professionally upon tea, but his were not original obser- 
Tations ; they were the opinions of the most eminent men he 
had collected to give to the world. But in 1678 appeared the 
first edition of a book which speedily ran through three large 
impressions, and had a considerable influence upon the intro- 
duction of tea. It was entitled Cornelio Bontekoe, Tractaat 
van hei excelUnste Kruyd Thee. Although this work was, 
flrom the extravagance of its commendations on tea, severely 
handled by some of the critics, it was translated into many lan- 
guages, and quoted as the highest authority. He pronounced 
tea to be the infallible cause of health, and that if mankind 
could be induced to drink a sufficient quantity of it, the inna- 
merable ills to which man is subject would not only be dimin- 
ished, but entirely unknown. He thinks that two hundred cups 
daily would not be too much. He is said to have been rewarded ' 
for his judgment by the liberality of the Dutch Eas# India Com- 
pany. Heydentrik Overoamp, who wrote the life of Bontekoe, 
states that his inducement to write was to recommend himself to 
his fellow-citizens, and to defend himself against his colleagues, 
who did not follow his theory or his practice. Etmuller recom- 
mended tea as a fine stomachic cephalic and antinephritic. 
Pechlin wrote a dialogue on tea, which he entitled Theophilus 
BibaculuSy and several poets indulged themselves in its praise. 
Petit wrote a poem ; Peter Francius, two Anacreontics ; Hein- 
rich, a Doric Melydrion ; and our poet-laureate, Tate, joined the 
melodious bards. Whilst it met with so much approbation, there 



ON COFFEE AND TEA. 305 

In regard to the medicinal qualities of tea, 
and its general influence upon the health of 
those who take it, reports and opinions are 



were likewise those who were not equally satisfied with its 
merits. Boerhaaye, Van Swieten, and others, attempted to stem 
the tide that was setting in its favor, but they have proved 
themselves incapable of resisting the general impression ;: for 
no beverage that has ever yet been introduced sits so agreoa^ly 
on the stomach, so refreshes the system,, soothes nervous iiTita- 
tion after fatigue, or forms a more grateful repast. It contrib- 
utes to the sobriety of a nation ; it imparts all the charms to 
society which spring from the enjoyment of conversation, with- 
out that excitement which follows upon a fermented drink. -^ 
Sigmondf p. 94. 

The introduction of tea-drinking into England has been as- \ 
cribed to Lord Arlington and Lord Orrery, and the year 1666,. 
the annus mirabilis of Dryden, has been assigned as the exact 
date ; but in the diary of Mr. Pepys, secretary to the Admi- 
ralty, the following is registered, — 'I sent for a cup of tea, a 
Chinese drink, of which I bad never drank before.* In the* 
diary of Henry, Earl of Clarendon, there is a memorandum, — 
* Pere Couplet supped with me, and after supper we 4iad tea, 
which he said was really as good as any he drank in China.' 
The first historical record, however, is an act of Parliamei t^ 
passed in the year 1660, 12 Carl. IL c. 23, which enacts that a 
duty should be laid of eight pence per gallon on all tea made 
and sold in coffee-houses; which were visited twice daily by 



306 ON COFFEE AND TEA. 

various and contradictory. Such is the diver- 
sity of temperaments and constitutions, that it 
cannot otherwise happen than that an article of 



officersi whose duty it was to ascertain what quantitj had been 
made. 

From An exact Description of the Growth, Quality, and 
Virtues of the Leaf Tea, by Thomas Oarway, in Exchange 
Alley, near the Royal Exchange, in London, Tobacconist, 
and Seller and Retailer of Tea and Coffee ; published about 
d660. 

' Tea is generally brought from China, and groweth there 
upon little shrubs and bushes, the branches whereof are well 
garnished with white flowers, that are yellow within, of the big- 
ness and fashion of sweet-brier, but in smell unlike, beariog 
thin green leaveSi about the bigness of scordium, myrtle, or 
.«umack, and is judged to be a kind of sumack. The said leaf 
is of such known virtues, that those very nations, so famous for 
antiquity, knowledge, and wisdom, do frequently sell it amoog 
themselves for .twice its weight in silver ; and the high estima- 
tion of the drink made therewith hath occasioned an inquiry 
into the nature thereof, amongst the most intelligent persons of 
all nations that have travelled in those parts, who, after exact 
tryal and experience by all wayes imaginable, have commended 
it to the use of their several countries, and for its virtues and 
operations, particularly as folio weth, viz. — 

* The quality is moderately hot, proper for winter and sum- 
mer. The drink is declared to be most wholesomoi preserviog 
in perfect health until extreme old age. 



ON COFFEE AND TEA. 307 

diet which is taken by one person with impu- 
nity, and even with benefit, shall in another 
occasion disagreeable and even serious conse- 

' The particular virtues are these : — 

* It maketh the body active and lusty. 

' It helpeth the headache, giddiness and heaviness thereof. 

' It removeth the obstructions of the spleen. 

' It taketh away the difficulty of breathing, opening obstruc- 
tions. 

'It is good against tipitude, distillations, and cleareth the 
fight. 

* It removeth lassitude, and cleanseth and purifieth acrid hu- 
mors, and a hot liver. 

' It is good against cruditiesi strengthening the weakness of 
the ventricle or stomach, causing good appetite and digestion, 
and particularly for men of corpulent body, and such as are 
great eaters of flesh. 

* It vanquisheth heavy dreams, easeth the frame, and strength- 
eneth the memory. 

* It overoometh superfluous sleep, and prevents sleepiness in 
general, a draught of the infusion being taken ; so that, without 
trouble, whole nights may be spent in study without hurt to the 
body, in that it moderately healeth and bindeth the mouth of the 



* It prevents and cures agues, surfets and fevers, by infusing 
a fit quantity of the leaf, thereby provoking a most gentle vomit 
and breathing of the pores, and hath been given with wonderful 



308 ON COFFEE AND TEA. 

qnences. Dr. CuUen considered tea as decid- 
edly narcotic and sedative in its effects; but 
the most superficial observer must see that tea 



* It (bdng prepared and drank with milk and water) strength- 
eiieth the inward parts, and preTents consumption ; and power- 
fully assuageth the pains of the bowels, or griping of the guts, 
and looseness. 

* And that the virtues and excellences of this leaf and drink 
are many and great, is evident and manifest by the high esteem 
and use of it (especially of late years) among the physicians and 
knowing men of France, Italy, Holland, and other parts of 
Christendom ; and in England it hath been sold in the leaf for 
six pounds, and sometimes for ten pounds the pound weight ; 
and in respect of its former scarceness and deamess, it hath been 
only used as a regalia in high treatments and entertainments, 
and presents made thereof to princes and grandees till the year 
1657. The said Thomas Garway did purchase a quantity there- 
of, and first publicly sold the said tea in leaf and drink, made 
according to the directions of the most knowing merchants and 
travellers in those eastern countries ; and upon knowledge and 
experience of the said Garway 's continued care and industry in 
obtaining the best tea, and making drink thereof, very many 
noblemen, physicians, and merchants, and gentlemen of quality, 
have ever since sent to him for the aaXd leaf, and daily resort to 
his house in Exchange Alley (^foresaid, to drink the drink 
thereof, 

* And that ignerance nor envy may have no ground or power 
to report, or suggest, that what is here asserted, of the virtues 



ON COFFEE AND TEA. 309 

has very little in common with other narcotics. 
The excitement which it produces upon the 
mind and upon the organs of digestion is of a 
durable and permanent kind, and it never, like 
other narcotics, leaves the system in a state of 
somnolency and intoxication. These remarks 
are to be understood of tea in the state in which 
we consume it, that is, the state of perfect dry- 
ness. In its green or recent state, it is said to 
possess a decided narcotic quality, capable of 
producing intoxication and other deleterious 



and exoellenoes of this preoioas leaf and drink, hath more of 
design than truth, for the justification of himself and the satis- 
faction of others, he hath here enumerated several authors, 
who, in their learned works, have expressly written and asserted 
the same and much more, in honor of this noble leaf and drink, 
Til. — Bontins, Ricoius, Jarricus, Almeyda, HorstinSi Alvarez 
Semeda, Martinivus in his China Atlas, and Alexander de 
Rhodes in his Voyage and Missions, in a large discourse of the 
ordering of this leaf, and the many virtues of the drink; printed 
at Paris, 1653, part x. chap. 13. 

' And to the end that all persons of eminency and quality, 
gentlemen and others, who have occasion for tea in leaf, may be 
supplyed, these are to give notice, that the said Thomas hath 
tea to sell, from sixteen to fifty shillings in the pound.* — Sig- 
mand, p. 96, &c. 



310 ox COFFEE AND TEA. 

eousequenoea. This property, however, is of a 
Tolatile Datme, and is lost in the process of 
diring mnd by a few months' age. 

A aTstaHine, volatile, salefiable substance 
has been foond in tea by chemists, and by them 
named Tkeime. It is said to exist in combina- 
uon with tannic acid in the leaves, and to be 
identical in its chemical composition with caf- 
ftime^ the alkaloid foond in coffee. Its chemical 
character has led laebig to suppose that, when 
used as an article of diet, it may promote the 
formation of tamrinej a peculiar compound in 
the bile. 

Tea, as it 13 brought to us in its dry state, 
has the effect of creating a lightness and ex- 
hilaration of mind, an increased action of the 
stomach in the process of digestion, and, above 
all. a vigilance and increased power of mental 
exertion. Dr. Johnson is recorded to have made 
the teapot the companion of his lucubrations, 
and to have taken immense quantities of its 
contents, to sustain the energies of his powerful 
mind during the prodigious labors which he 
accomplished. In its other properties tea is 
astrin^nt and antiseptic. It visibly produces 



ON COFFEE AND TEA. 311 

no injurious effect upon the generality of per- 
sons who take it from infancy to old age. It 
is remarked by Desfontaines, that no vegetable 
is known, the infusion of which can be drunk 
BO often and in such large quantities, without 
disgust The Chinese regard it as highly salu- 
brious. They mix with it neither milk nor 
sugar, but drink it pure, sometimes holding a 
piece of sugar in the mouth. The constant 
use which this people have made of it for so 
many ages seems to prove that, when rightly 
prepared, it is destitute at least of injurious 
properties. Professor Kalm states, that tea is 
the best corrector of bad water, and that he 
derived from it great comfort and benefit dur- 
ing the illness and inconvenience of a long sea 
voyage. It is, in fact, one of the best remedies 
for slight sea-sickness. An extract made of 
tea is in high repute as a medicine in China, 
and is said to remove obstructions and pro- 
mote perspiration. Dr. Lettsom found that 
tea given in fine powder, in doses of thirty 
grains once in three or four hours, produced 
nausea and diaphoresis, and appeared to di- 
minish the heat accompanying inflammatory 



31S OS COrPKB AXB TBA« 

comphintgL The finer and more green is the 
tea, the more powerful are its specific effects. 

Nercftlieless;, a Taiietj of injarioos conse* 
qnences have been ascribed to tea, and many 
no donbt kare arisen, either firom its abuse, or 
fipom the idjoeyncrasies of those who have been 
the subjects of its influence. Some persons 
eoffipiain that, after taking freely of tea, a ner- 
Tous agitation of the whole fiame commences. 
The hands trembte, so as to be incapable of 
writing ; the limbs experience a loss of power, 
and perform their office with difficulty ; at the 
same time a confusion of ideas incapacitates 
the mind for any close or active train of think- 
ing. There are even some persons, in whom 
tea produces great nausea and sickness, with 
spasmodic pains of the stomach and bowels, 
and an uncontrollable agitation of spirits on the 
least hurry, noise or disturbance. These symp- 
toms, however, are the effect of some peculiarity 
in the constitution, a great mobility of the ner- 
vous system, and generally of a slender, en- 
feebled and effeminate frame. They may, how- 
ever, arise in all persons from an excessive use, 
either as it respects the quantity or strength of 



ON COFFEE AND TEA. S13 

the tea, or the want of nourishment taken at 
the same time. I believe the number of per- 
sons will be found to be exceedingly* small, who 
cannot take tea in moderate quantities and ac- 
companied by food, without any inconvenience 
whatever. 

The inquiry is very often made of physicians, 
Which is the most wholesome article of food, 
coffee or tea ? The prejudices of most persons 
are ranged on one side or the other of this ques- 
tion, and even practitioners themselves are apt 
to fall into one or the other extreme. One of 
the oldest and most distinguished physicians of 
this city,* being asked what was the difference 
in effect between tea and coffee, replied, that 
^ One is poison, and the other not.' A physi- 
cian of equal eminence, in Philadelphia,! de- 
cided on the properties of the two with equal 
positiveness, taking, however, the opposite side 
of the question. The truth is, that there are 
scarcely any two substances in the materia 
medica which bear a closer relation, or more 
nearly resemble each other, in their properties, 

♦ Dr. S. Danforth. f I>r. B. S. Barton. 



314 



ON COFFEE AND TEA. 



than coffee and tea. Tea is more astringent 
than coffee, and coffee of the strength com- 
monly used is somewhat more stimulating 
than tea, — otherwise the differences which 
have been ascribed to them have mostly arisen 
from the accidental opinions of individuals, 
whose taste and idiosyncrasies have rendered 
them fond of the one and averse to the other. 



REPORT 

ON THE 

ACTION OF COCHITUATE WATER 
ON LEAD PIPES; 

AND THE INFLUENCE 07 THE SAME ON HEALTH. 
[From the Amerkaa journal of Medical ScienceB for 1852.] 

The committee appointed by the Society of 
Medical Improvement in Boston, for investiga- 
ting the question of the occurrence of any dis- 
eases attributable to the presence of lead in the 
aqueduct water introduced into the city, from 
the Cochituate Lake, report as follows : — 

That from an extensive inquiry among physi- 
cians, and also from the bills of mortality, they 
are led to believe that the health of the city of 
Boston has been uncommonly good during seve- 
ral years since the introduction of Cochituate 
water, — and they have not learned that any 



316 ACTION OP COCHITUATB WATER 

well-marked cases of the diseases usually attrib- 
uted to lead, have occurred, which were not 
traceable to some other cause than the use of 
Cochituate water drawn from leaden pipes. 

It appears from the experiments of Professor 
Horsford, that the water of the Schuylkill and 
Croton rivers, and of Jamaica and Cochituate 
lakes, acts uport the surface of the lead so as to 
take up a small portion of that metal during the 
first two or three days of its contact. But after 
a few days the surface of the lead becomes coat- 
ed with an insoluble compound which protects 
the lead for the most part from the further 
action of the water. Nevertheless, traces of lead 
are reported to have been found by various 
chemists in specimens of some of these -waters, 
when greatly reduced by evaporation. 

In consequence of the extensive use made of 
lead for various economical purposes, no person 
in civilized society can expect to escape from 
the reception of that metal in minute quantities 
into- the body. The presence of lead in the 
paint of dwelling-houses and furniture, of water- 
buckets and other culinary apparatus, in vessels 
made of leaden alloys or soldered with the same, 



ON LEAD PIPES. 317 

in the lining of tea-chests, in flint-glass, and in 
the glazing of coarse pottery, furnishes but a 
part of the examples which indicate our expo- 
sure to receive this metal in our daily food. To 
these examples it may be added that physicians 
give lead to their patients sometimes for weeks 
successively, and apply solutions and solid com- 
pounds of the metal to absorbing surfaces for 
longer periods ; that persons are known to carry 
shot and bullets in their flesh during a long life ; 
and, finally, that reliable chemists testify that 
lead naturally exists in the solids and fluids of 
man, and in those of some of the animals on 
which he feeds. 

From all these facts we are authorized to 
draw the conclusion that in the present state of 
our knowledge, the presence of lead in a very 
minute amount, like the presence of other sub- 
stances in infinitesimal quantities, is inopera- 
tive upon the living body. 

It is a general law known to medical men, 
and to which there are not many exceptions, 
that diseases and symptoms produced by speci- 
fic metallic agents, such as mercury, lead, and 
arsenic, do not cease until after the withdrawal 



318 ACTION OF COCIIITITATB WATER 

of those agents. Bat it appears from the re- 
cords of the Massachusetts General Hospital, 
during the last twenty years, as well as from 
the private experience of physicians, that many 
cases of lead colic and paralysis, acquired by 
persons who work in that metal, have got well 
under the daily use of water delivered from 
leaden pipes. This would not probably have 
been the case did the water contain any delete- 
rious amount of lead in solution or suspension. 
The principal diseases ascribed by Tanquerel, 
and some subsequent writers, to the presence of 
lead, are colic, paralysis, arthralgia, and ence- 
phalopathy. Of these the committee have not 
been able to learn that there has been any sen- 
sible increase in this city since the introduction 
of Cochituate water. Of lead colic, but one 
case has entered the hospital during the last 
two years, which is a smaller proportion than 
the average of the preceding twenty years. Of 
lead paralysis there have been but two cases 
within the same period, both occurring to work- 
men in lead. Of arthralgia or pain in the joints 
or limbs directly traceable to lead, it is believed 
there have not been a sufficient number of cases 



ON LEAD PIPES. 319 

at any time to attract extensively the notice of 
our physicians. As to encephalopathy, a gene- 
ral term used by some writers to express cerebral 
disease, and including coma, delirium, convul- 
sions, &c., there is apparently no more reason 
for attributing it to lead, than consumption, 
fever, or any other common disease which may 
happen to occur among lead workmen. 

It is obvious to a medical reader, that many 
of the cases detailed by writers on lead diseases 
are coincidences rather than consequences ; and 
therefore do not furnish a ground for general 
laws. Such is the case when persons have been 
supposed to have contracted lead diseases by 
sleeping in newly-painted apartments, where, 
unless the lead were volatile, it could not leave 
the walls to enter the bodies of the patients. It 
is also the case when solitary examples of com- 
mon diseases are ascribed to lead, when it is 
known that they more frequently result from 
different causes. It is also often the case when 
the reports of credulous and incompetent ob- 
servers are received as scientific authority. 

In a late ' English Report by the Government 
Commissioners on the Chemical Quality of the 



320 ACTION OF COCHITITATE WATER 

Supply of Water to the Metropolis,* of London, 
made in 1851, by Drs. Th. Graham, W. A. Mil- 
ler, and A. W. Hoffman, men of high standing 
in the scientific world, an investigation is made 
of the condition of the various waters now 
supplied to that city. In this Report, the com- 
missioners state (page 32) that * no recent or 
authenticated case can be cited of the health of 
any of the numerous towns lately supplied with 
soft water, being affected by the use of leaden 
distributing tubes.' Again, on page 33, the 
commissioners say : * We are disposed, there- 
fore, to conclude that the danger from lead in 
towns supplied with water, has been overrated ; 
and that, with a supply from the Water Com- 
panies, not less frequent than daily, no danger 
is to be apprehended from the use of the present 
distributing apparatus, with any supply of mod- 
erately soft water which the metropolis is likely 
to obtain.' 

On the present occasion it is by no means 
intended to deny the well-known fact, that cer- 
tain acid liquors, also that the water of certain 
springs and wells, may and do act upon and 
even dissolve lead in such quantities as to prove 



ON LEAD PIPES. 321 

injurious to human health. It is also possible 
that at certain seasons, and under certain cir- 
cumstances, the soft water of lakes and rivers 
may contain organic or other products, which 
may take up in solution a minute portion of 
the pipes through which they pass. And it may 
even be conceded as possible, that a few suscep* 
tible and predisposed individuals will get lead 
diseases while using this water. Nevertheless, 
lead is a very convenient material to be used in 
aqueducts. It is more cheaply manufactured, 
more conveniently applied, and more readily 
irepaired, than any other material. And while 
this is the case, mankind will not be prevented 
from employing it The general law derived 
from the experience of the large cities of this 
country and of Europe is, that its employment 
for the conveyance of soft water is safe. To 
this law the few recorded cases of disease, if 
genuine, must be regarded as exceptions. And 
it should be borne in mind, that nearly all th6 
great agents which minister to the physical hap» 
piness and improvement of man, are fraught 
with more or less danger. Ships and railroads, 
fira and water, food, drink and medicine destroy 
31 



822 ACTION OF COCHITUATE WATER. 

annually multitudes of our species.' Neverthe- 
less, all these agents increase every year in use, 
with the increase of wealth and civilization. 
And as a humble example under the same law, 
it is not probable that the leaden aqueduct will 
be abandoned, on account of the inconsider- 
able risk which it may involve of occasioning 
disease. From the preseht state of our knowl- 
edge, we are authorized to conclude that the in- 
surance on a citizen of Boston, New York, Phil- 
adelphia, ' or London, against lead colic, is 
probably worth much less than his insurance 
would be on a voyage across the Atlantic, or 
on a railroad for twenty miles. 



ON THE 

HISTORY AND USE OF TOBACCO. 

X08TLT nU>M THE AXEKIOAN MEDICAL BOTANY, VOL. I. 

It is a remarkable law of the animal economy, 
that the power of use and habit is capable of 
reconciling the system to bear with impunity 
what in its unaccustomed state proves deleteri- 
ous or even fatal. It is a fact that many sub- 
stances in the Materia Medica lose their effect 
after the continuance of their use for a certain 
length of time, so that if we would realize their 
original operation, we must increase their dose 
in proportion as the body becomes accustomed 
and insensible to their stimulus. This is par- 
ticularly exemplified in the narcotics. Several 
of these substances, which at first are not only 
nauseous and disgusting in their sensible quali- 
ties, but highly injurious in their influence upon 



3134 HIBTORV AND USE OF TOBACCO. 

health, are . so changed in their effect by habit- 
ual use, as to become to those who employ 
them an indispensable conckfort and a first-rate I 
luxury of Ufe. 

In its external and sensible properties, there 
is no plant which has less to recommend it than 
the common tobacco- Its taste in the grem 
state is acrid, nauseous and repiilsive, and a 
smalt quantity taken into the stomach excitea 
violent vomiting, attended with other alarming 
symptoms. Yet the first person who had cour- 
age and patience enough to persevere in its use, 
until habit had overcome his original disgust, 
eventually found in it a pleasing sedative, ft 
soother of care, and a material addition to the 
pleasures of Hfe. Its use, which originated 
among savages, has spread into every civilized 
country ; it has made its way against the de* 
clamations of the learned, and the prohibitioitf 
of civil and religious authority, and it now gives 
rise to an extensive branch of agriculturei or of 
commerce, in every part of the globe. 

Tobacco was in use among the aborigines d 
America, at the time of its discovery. They 
employed it as incense in their sacrificial fim 



HISTORY AND USE OF TOBACCO. 325 

believing that the odor of it was grateful to 
their gods. The priests of some tribes swallow- 
ed the smoke of this plant to excite in them a 
spirit of divination, and this they did to a de- 
gree which threw them into a stupor of many- 
hours' continuance. When recovered from this 
fit of intoxication, they asserted that they had 
held a conference with the devil, and had learn- 
ed from him the course of future events. Their 
physicians also got inebriated with the smoke, 
and pretended that while under the influence of 
this intoxication they were admitted to the 
council of the gods, who revealed to them the 
event of diseases. 

In 1559, tobacco was sent into Spain and 
Portugal by Hernandez de Toledo, and from 
thence it was carried into France as a curiosity 
by Jean Nicot or Nicotius, ambassador at the 
court of Lisbon, whose name is now immortal- 
ized by its application to this genus of plants. 
From this period the use of tobacco spread 
rapidly through the continent, and in half a 
century it was known in most countries in Eu- 
rope. The rich indulged in it, as a luxury of 
the highest kind ; and the poor gave themselves 



326 BISTORT AND USE OP TOBACCO. 

up to it, as a solace for the miseries of life. Its 
use became so general and so excessive, that in 
many countries the constituted authorities, both 
of church and state, found it necessary to inter- 
pose, and to stop the extravagant indulgence in 
it by severe prohibitions. James the First of 
England, besides writing a book against it, 
called his ^ Counterblast to Tobacco,' gave 
orders that no jdanter in Virginia should cul- 
tivate more than one hundred pounds. Pope 
Urban the Eighth published a decree of excom- 
munication against all who took snuff iu the 
church. Smoking was forbidden in Russia 
under penalty of having the nose cut off. In 
Switzerland a tribunal ( Ckambre du tabac) was 
instituted for the express purpose of trying 
transgressors in tobacco. A Turk, who was 
found smoking in Constantinople, was conduct- 
ed through the streets of that city with his pipe 
transfixed through his nose. 

Even in this country, where- the use of to- 
bacco originated, we find our puritanic ances- 
tors guarding against its abuse by salutary 
statutes. In the old Massachusetts colony laws 
is an act laying a penalty upon any one ' who 



HISTORY AND U»E OF TOBACCO. 327 

shall smoke tobacco within twenty poles of any 
house ;' or who shall 'take tobacco in aity inn 
or common victaalling house, except in a pri- 
vate room, so as that neither the master of the 
said house nor any other guest shall take offence 
thereat.' In the earliest records of Harvard 
University soon after its foundation, is a regula* 
tion of this kind : * No scholar shall take tobac- 
co, unless permitted by the president, with the 
consent of their parents and guardians, and on 
good reason first given by a physician, and then 
in a sober and private manner.' 

While the legal authorities in various parts of 
the world took upon them to control the abuse 
of this fascinating weed, the literati of different 
countries entered warmly into the discussion of 
its merits and its faults. Among its advocates 
were Castor Duranti and Raphael Thorius, both 
of whom wrote Latin poems expressly in its 
praise. The performance of the latter is entitled 
a * Hymn to Tobacco,' and is very lavish in 
ascriptions to this plant, which he styles the 
< gift of heaven and the ornament of earth.' So 
warm were the prejudices of its advocates, that 
it obtained the feputation of a general panacea. 



328 HI8T0RT AND USE OF TOBACCO. 

and the catalogue of diseases which it was 
announced to cure, amounted almost to a 
<5omplete nosology. 

But the opinions of its adversaries were not 
less extravagant upon the other extreme. It is 
remarkable that in the days of its first general 
introduction, no man spoke about it with cool- 
«iess and indifference, but every one warmly 
•espoused its censure or its praise. Camden, in 
iiis Life of Queen Elizabeth, says, that men used 
tobacco every where, some for wantonness and 
.some for health's sake ; and that ' with insatia- 
ble desire and greediness, they sucked the stink- 
ing smoke thereof through an earthen pipe, 
which they presently blew out again at their 
nostrils ; — so that Englishmen's bodies were so 
delighted with this plant, that they seemed as it 
were degenerated into barbarians.' 

Dr. Venner, in a work entitled Via recta ad 
vitam longamj published at London in 1638, 
gives a brief summary of the injuries done by 
tobacco. ^ It drieth the brain, dimmeth the 
sight, vitiateth the smell, hurteth the stomach, 
destroyeth the concoction, disturbeth the humors 
and spirits, corrupteth the breath, induceth a 



if 

HISTORY AND USE OF TOBACCO. 329 

trembling of the limbs, exsiccateth the winde 
pipe, lungs and liver, annoyeth the. milt, scoreh- 
eth the heart and causeth the blood to be adnst- 
ed. In a word, it overthroweth the spirits, 
perverteth the underi^tanding, and confoundeth 
the senses with sudden astonishment and stu- 
piditie of the whole body.' 

A poetical philippic, called * Tobacco batter- 
red,' was published in the reign of King James, 
by Joshua Sylvester, in which he compares to- 
bacco to gunpowder, and pipes to guns ; making 
the mischief of the two equal. But the most 
celebrated of all invectives against tobacco was 
the * Counterblast' of King James I. That 
weak monarch gave vent to his prejudices 
against this herb in a publication, in which he 
professes to disprove all the alleged grounds for 
the toleration of tobacco, and warns his subjects 
in a most earnest manner not to sin against 
God, and harm their own persons and goods, 
and render themselves scorned and contemned 
by strangers, who should come among them; 
by persevering in a custom loathsome to the 
eye, hateful to the nose, and baneful to the 
brain.' 



330 HISTORY AND USE OP TOBACCO. 

Such were the commotions excited by the 
introduction and spreaxling of an article, the use 
of which has now become so common as scarce- 
ly to attract notice. This article is the product 
of several species of Nicotiana, but chiefly of 
the N. tabacum or Virginian tobacco, and the 
N. rustica, sometimes called English tobacco, 
and being the sort which Sir Walter Raleigh 
introduced at the court of Queen Elizabeth. 
Another species, N. fruticosa, is said to have 
been cultivated in the East prior to the discovery^ 
of America. The Indians on the banks of the 
Missouri and Columbia rivers cultivate for use 
the N. quadrivalvis of Pursh and Nuttall. It 
has been remarked that the tobacco of warm 
climates is more mild in its flavor, while that 
raised in colder latitudes is more strong and 
pungent The Bengal tobacco, of which the 
sheroots are made, is one of the most mild in its 
properties. After this is the West India tobac- 
co which affords the Havana cigars. Next is 
the tobacco of our Southern States, and lastly 

the tobacco raised in the northern parts of the 

« 
Union, which is the most acrimonious and pun- 
gent of all. 



HISTORY AND USE OF TpBACCO. 331 

Chemists have extracted from tobacco a color- 
less liquid alkaloid, which they have called iW- 
cotine. It is acrid to the taste and smell, forms 
neutral compounds with acids, and ' is intensely 
poisonous in minute quantities. Nicotianine^ 
another product, is a concrete volatile oil, like 
camphor, and resembles tobacco in its proper- 
ties* 

Among the substances used by Sir Benjamin 
Brodie in his experiments on vegetable poisons, 
was an empyreumatic oil of tobacco prepared 
by Mr. Brande by distilling the leaves of tobacco 
in a heat above that of boiling water* A quan- 
tity of watery fluid came over, on the surface of 
which was a film of unctuous substance, which 
he calls the empyreumatic oil. Mr. Brodie 
found that two drops of this oil applied to the 
tongue of a young cat with an interval of fifteen 
minutes occasioned death. A single drop sus- 
pended in an ounce of water and injected into 
the rectum of a cat, produced death in about 
five minutes. One drop suspended in an ounce 
and a half of mucilage and thrown into the rec- 
tum of a dog, produced violent symptoms, and 
a repetition of the experiment killed him. 



332 HISTORY AND USB OF TOBACCO. 

Tobacco has been used both as a luxury and 
prophylactic, and as a medicine. In the former 
cases it has not been taken internally, but only 
kept in contact with absorbing surfaces. It is 
well known, that to the mouth it is applied in 
substance and in smoke ; and to the nose in the 
form of powder. The opinion which at one 
time prevailed of its power to prolong life and 
to secure immunity from diseases is now pretty 
fully abandoned. It has no prophylactic repu- 
tation except as a preservation for the teeth, 
and in some degree as a protection against the 
contagion of epidemics. In both these cases it 
has acquired a certain degree of confidence, 
though it is probably inferior to many other 
substances for both these purposes. 

As to its effects upon longevity, the great 
frequency of its use, and the facts and observa- 
tions of Sir John Sinclair, render it improbable 
that when moderately taken, it has much influ- 
ence in wearing out the constitution, or abridg- 
ing the usual period of life. But like all other 
narcotics its excessive use or abuse must impair 
the health and engender disease. Of the differ- 
ent modes of using tobacco, it is probable that 



HISTORY AND USE OP TOBACCO. 333 

smoking is the most injurious, and the most 
capable of abuse, since in this process the active 
principles of the tobacco are volatilized with the 
smoke, and are extensively applied to the lungs 
as well as the mouth and nose and fauces. 

As a medicine, this plant has been employed 
in a variety of ways for the alleviation and cure 
of diseases. Externally it has been applied 
with benefit in tinea capitis and in some com- 
plaints occasioned by the presence of insects. 
In the form of a cataplasm applied to the pit of 
the stomach it occasions severe vomiting. The 
prostration of strength and other distressing 
symptoms which attend this application, must 
prevent its general employment. Still it may be 
remembered as an auxiliary in some cases where 
other emetics have failed to operate. A surgeon 
in the U. S. Army informed me that the soldiers 
bad an expedient to exempt themselves from 
duty, by wearing a piece of tobacco under each 
armpit, until the most alarming symptoms of 
real illness appeared in the whole system. 

Dr. James Currie has recorded a case of epi- 
lepsy cured by the external use of tobacco. A 
cataplasm was applied to the stomach for seve- 



334 HISTORY AND USE OF TOBACCO. 

ral days about half an hour before the expected 
return of the paroxysm. A violent impression 
was produced each time upon the system, the 
paroxysm prerented, and the diseased associa- 
tion apparently broken up. Two cases of obsti- 
nate and dangerous intermittent were intercept- * 
ed in the same manner by a decoction of half a 
drachm of tobacco in four ounces of water, 
thrown up as an enema, a. short period before 
the time of the expected paroxysm. 

The tobacco enema was formerly recommend- 
ed in colic, nephritic complaints, &c. In later 
years it has been extensively employed in aiding 
the reduction of strangulated hernia. But since 
the introduction of ether and chloroform in the 
treatment of this disease, the use of tobacco has 
been little resorted to. 

When the infusion is not used, an injection 
of tobacco smoke into the rectum frequently 
produces the same consequences. The smoke 
may be made to penetrate farther than any 
liquid, and it is equally efficacious, from the 
activity of the volatile parts. It was formerly 
much used in the restoration of persons appa- 

itly dead from drowning, but of late years it 



HISTORY AND USE OP TOBACCO. 335 

has gone more into disuse. From the sedative 
effect of tobacco, the tendency to syncope and 
the great prostration of strength which it occa- 
sions in ordinary cases, it is probable that its 
employment in cases of asphyxia from drown- 
ing, must assist in extinguishing rather than in 
rekindling the spark of life. 

Tobacco has been employed with some suc- 
cess in the locked jaw, both of warm and cold 
climates, by enemas of the infusion and of the 
smoke. These applications generally produce 
syncope and deathlike sickness in the patient, 
but by prudent management of them, the dis- 
ease has sometimes been overcome. 

This powerful medicine is reported to have 
been also employed with some palliative effect 
in hydrophobia and certain other spasmodic dis- 
eases. Its internal use however requires great 
caution, since patients have in various instances 
been destroyed by improper quantities adminis- 
tered by the hands of the unskilful or unwary. 
Notwithstanding the common use and extensive 
consumption of tobacco in its various forms, it 
must unquestionably be ranked among narcotic 
poisons of the most active class. The great 



336 HISTORY AND USE OF TOBACCO. 

prostration of strength, excessive giddiness, 
fainting, and violent affections of the alimentary 
canal, which often attend its internal use, make 
it proper that so potent a drug should be resort- 
ed to by medical men, only in restricted doses 
and on occasions of magnitude. 



ON THE 

EARLY HISTORY OF MEDICINE. 

ntOM A REVIEW OF MILLEB's DISQUISITIONS ON THE HISTOBT OF 
MEDICINE, PUBUSHED IN THE NEW ENGIAND JOIOLNAL OF 
MEDICINE AND 8DBGEBT, APBIL, 1812. 

It is commonly understood that the history 
of medicine has already been traced with suffi- 
cient accuracy in all ages and countries, where 
authorities for its elucidation are extant. The 
labors of Le Clerc, Friend, Haller, and Cabanis, 
seem to have left very little to be wished in this 
department of science. But, although a general 
history of medicine is by no means a desidera- 
tum at the present day, yet there are undoubt- 
edly parts of it which are still susceptible of 
correction or enlargement. Dr. Edward Miller, 
the author of the present disquisitions, appris- 
es us that he has been induced to attempt 
23 



338 ON THE EABLT 

them, partly firom some singular traits which he 
thonght he had discovered in the medicine of 
the early Greeks, and partly from the extraor- 
dinary advancement made of late years in 
Sanscrit literature. By means of this last we 
are informed that, long previous to its intro- 
duction into Europe, the science of healing had 
made very considerable progress in Hindostan ; 
yet to commemorate its details, or appreciate 
its merits, has never yet been the task of any 
historian in medicine. This new field of re- 
search Professor Miller has attempted to culti- 
vate, and the fruits of his oriental inquiries are 
to constitute a second volume of Disquisitions. 
In the mean time, the present volume, contain- 
ing general archaeological remarks, with specu- 
lations on the primitive physic of Greece and 
Egypt, is submitted to the ordeal of the public 
It must be exceedingly obvious that, prior to 
the introduction of letters, no very definite in- 
formation can be expected with regard to the 
state of medical practice in any country. If 
the traditionary account of the most important 
and notorious events, such as battles and sieges, 
the rise and fall of heroes and of empires, is 



HISTORY OP MEDICINE. 339 

involved in necessary uncertainty ; we cannot 
expect that a complex science, closely inter- 
woven in early ages with mystery and super- 
stition, should reach us in a state capable of 
affording much satisfaction. The few tradi- 
tions handed down to us from the primitive 
ages, afford matter for speculation to the cu- 
rious, but yield no certainty to the accurate. 

Dr. Miller, seemingly aware of the difficul- 
ties attendant on this part of his subject, has 
thought proper to commence the present un- 
dertaking with a sort of history a priorij or 
presumptive history^ of medicine in its primaeval 
state. He begins with stating the progress of 
observation and reasoning, which would natu- 
rally be made by the early and rude nations, in 
regard to the phenomena of life, health, disease 
and death. He details the manner in which a 
gradual acquaintance would be formed with 
the nutritious, medical and deleterious effects of 
the various productions of nature; and from 
hence assigns to the Materia Medica the su- 
preme honors of antiquity. Afterwards comes 
the knowledge of practical physic, of anatomy 
and of surgery, in proportion as men became 



340 ON THE EARLY 

habituated to watch the progress and core of 
diseases, to butcher and dissect brute animals, 
to sacrifice, eat, or embalm their own species, 
and to inflict or remedy the wounds and inju- 
ries occasioned in war or elsewhere. 

After this we are presented with an interest- 
ing account of that tract of territory, which we 
have reason to believe contained the earliest 
tribes of our species. To this region, composed 
chiefly of Egypt, Ethiopia, Turkey, Arabia, 
Persia, and India, Dr. M. gives the collective 
name of the Primteval Chersonese.* He expa- 
tiates on the exuberance of its soil, the variety 
and value of its productions, its inducements 
for agriculture, and facilities for commercial 
intercourse. He represents that six races or 
stems have, from time immemorial, occupied 
this ample and favored portion of the earth's 
surface. These are the Chinese, the Hindus, 
the Tartars, the Iranians, (or Assyrians,) the 
Arabs, and lastly the Nilotic tribes, or those of 
Egypt and Ethiopia. Among these he assigns 

* * This applioation of the term Chersonese, we think, rather 
-^-^tqhes its ancient signification. 



HISTORY OF MEDICINE. 341 

an undoubted claim for priority of civilization 
to three nations, the Hindus, the Iranians, and 
the tribes inhabiting the banks of the Nile. 
The individual claims of these three he com- 
promises by endeavoring to prove, from tradi- 
tion and history, from identity of language, &c., 
from conformity of religious and philosophical 
opinions, and, lastly, from similitude of corpo- 
real structure; that they were only separate 
branches of one and the same individual family 
or race of men. In this investigation the au- 
thor gives proofs of extensive and assiduous 
research. 

Before quitting the general subject of the 
Primaeval Chersonese, we are made minutely 
acquainted with its natural productions, or 
those articles which must have constituted the 
earliest food and medicine of man. 

We now come to the particular history of 
medicine in early Greece, as it existed during 
the traditionary ages. On collecting the scat- 
tered rays of information respecting this period, 
chiefly from the poets, our author alights on a 
curious circumstance, which he makes the basis 
of this chapter, viz., " That, for its first discove- 



342 ON THE EARLY 

ries and improyements, medicine in Greece 
appears indebted almost wholly to two orders 
of men, from whom such benefit was not likely 
to be derived, viz. : 

< 1. The chiefs or sovereigns of its different 
small communities. 

* 2. The priests or ministers of religion.' 

Upon this ground the author proceeds to 
give us two dissertations on the heroic and 
the priestly medicine of Greece; — and first, of 
•heroic medicine.' 

On this subject we are told that scarcely a 
royal or distinguished personage, during the 
traditionary period, can be named, to whom 
some degree of medical skill has not been ac- 
corded. The ascription of this honor is traced 
to several causes, such as the obscurity which 
hangs over the beginning of all arts; the vene- 
ration which savage tribes entertain for the 
character of their leaders ; and the policy which 
would lead these chiefs to maintain their as- 
cendency, by the display of every species of 
personal merit or skill, that of medicine being 
not the least imposing. The practice of these 
heroic physicians, which the author believes to 



HISTORY OF MEDICINR. 843 

have been chiefly surgical, is illustrated by 
various accounts of the therapeutic exploits 
performed by several individuals. These are 
Chiron, Esculapius, Machaon, Podalirius, Achil- 
les, Teucer, &c. &c. &c. The claims for medi- 
cal distinction are, indeed, so numerous that 
they may be said to amount to no distinction 
at all, since every man whose name, has been 
handed down to us as holding a rank in a 
tolerable degree above the vulgar, would seem 
entitled to enrolment among the faculty. Chi- 
ron the Centaur is stated to have been precep- 
tor to nearly all the heroes who figured in the 
Argonautic and Trojan expeditions. Now as 
Chiron was one of those universal geniuses, 
who was competent to exercise the arduous 
and multiform functions of warrior and necro- 
mancer, of horse-breaker, musician, and doctor, 
it must be supposed that those who received 
the supreme honors of his school, were not 
ushered into the world without a smattering 
of these various accomplishments. Hence the 
crew of the Argo might, on emergency, be con- 
sidered a crew of the faculty ; and the council 
of warriors in Agamemnon's camp required 



344 ON THB RASLT 

only a change of occasion to resolve them into 
a jury of doctors. 

We have already intimated that any accounts 
now extant, respecting the medicine of the earfy 
Crreeks most be extremely nnsatisfactory. We 
may now add, that, from the few authorities 
we have, it may be doubted whether any pro- 
ficiency in medicine was ever made among 
them, beyond what a rude individual would 
naturally attain in the science of self-preserva- 
tion. The boasted achievements performed by 
their distinguished personages apparently con- 
sisted in some trifling and obvious operations, 
or else in such exa^erated and miraculous 
performances, as distance all possibility of be- 
lief. The heroic or surgical practice among 
them was confined chiefly to the extraction of 
weapons and the dressing of wounds. The 
highest praise which Homer has bestowed on 
the medical or suigical profession is contained 
in the following lines: 

Which amount to simply this, — that <one 



HISTORY OF MEDICINE. 345 

doctor is worth a host of other men, to cut out 
arrows, and apply mUd dresshigs.' And, in- 
deed, whenever he tells us of such a man being 
actually engaged in practice, it is commonly in 
one or the other of the above processes. Now 
it could require no great depth of intellect to dis- 
cover, that if a barbed arrow stuck in the flesh, 
it could most easily be removed by excision, 
and that if a wound became dry and painful 
from exposure to the air, it might be made more 
comfortable by covering it with emollient appli- 
cations. 

But, with such humble and obvious opera- 
tions as these, the ancient physicians could not 
have sustained their elevated rank in society, 
and substantiated their claims upon immortal- 
ity. It became necessary, in order to secure 
complete ascendency over the public mind, 
that they should profess an intercourse with 
the gods, a knowledge of mysterious charms 
'and incantations, and other special gifts pecu- 
liar to jugglers in all nations since their time. 
Very surprising stories are told of Melampus, 
Polyidus, and Chiron. These, however, are 
small when compared with the feats of Escu- 



346 ON THE EARLY 

lapius, the prince of physicians, and the deified 
inventor of medicine. Esculapias, in addition 
to many other astonishing powers, was gifted 
with a very remarkable faculty, peculiar to 
himself, of raising at pleasure the dead to life. 
Not less than six or seven instances are on 
record of distinguished corpses that were bene- 
fited by the exertion of this happy talent. It 
is impossible to say how far the bounds of sci- 
ence might have been enlarged by so mighty a 
genius, had not Pluto taken alarm at his pro* 
gress, and presented a memorial to Jupiter, 
humbly showing, that if a stop was not put 
to the career of this officious mortal, people 
would soon cease to die, and hell would be- 
come a desert; whereupon Jupiter interposed, 
and killed the wonder-working doctor with his 
thunderbolts. 

There is reason to believe, from what* has 
been said, that the cures effected by these medi- 
cal worthies were either inconsiderable and real, 
or else preternatural and counterfeited. We 
have additional ground for this belief, on find- 
ing that frequently, when emergencies occurred, 
opening a fine field ;for medical practice, the 



HISTORY OF MEDICINE. 34? 

champions for physic were totally idle or inef- 
ficient. When a pestilence broke out among 
the Greeks at the Trojan war, we find them 
with all their heroic and priestly medicine, re*- 
sorting not to their drugs and preparations, not 
to any regular system of practice,, but simply 
to superstitious prayers, rites and atonements^ 
The Argonauts, with Esculapius at their head,, 
required the aid of a sorceress, before they 
could administer an opiate to the dragon that 
watched their fleece. Chiron died of a wound 
or ulcer in the leg, and Achilles of one in the 
heel. Such disasters as these last were not to 
be expected, after what Dr. Miller tells us in his 
account of Chiron : — * So celebrated was he in 
tradition for the cure of ulcers, as we are in- 
formed by Galen, that when a sore was obsti- 
nate and could not be healed up, it was cus- 
tomary in later times to call it a Chironian 
ulcer, intimating, by the expression, that it was 
an ailment of such malignity, as to baflie the 
skill even of Chiron himself.* 

Now, we conceive, it was no compliment to 
the Centaur to name only incurables after him. 
We also conceive that, between Galen and Dr. 



348 ON TUB EARLY 

Miller, the origin of the term Chironian ulcer 
may have been mistaken, and that it may be 
derived, not from the skill of Chiron in curing 
malignant ulcers, but from the circumstance of 
'his having languished and died under a ma- 
lignant ulcer. Oalen informs us on this subject, 
that of the phagedsena, or eating ulcer, there 
were different species, called the Chironian and 
Telephian : ^ Harum species qusedam sunt, quce 
Chironia et Telephia dicuntur.' In another 
place he tells us that the Telephian ulcer was 
«o called from Telephus, who was afflicted with 
it. Now the case of Chiron was not dissimilar 
to that of Telephus, as both their maladies were 
occasioned by the wound of a spear, only Te- 
lephus got well, whereas Chiron, after languish- 
ing with his lame leg for nine days, either 
died, or was made into a constellation ; for all 
which the reader may consult Ovid. Fastorum 
V. 379 -414. 

Machaon, the son of Esculapius, when 
wounded at the siege of Troy, retired with 
Nestor to his tent, where they took from the 
hands of a woman a farrago of onions, cheese, 
meal, honey, and wine. From Pope's transla- 



HISTORY OF MEDICINE.. 349 

tion of this account in the Iliad, which Dr. M. 
has quoted, we are led to suppose that this 
potion was a prescription of the physician him- 
self for his own case. Witness the following 

lines: 

• 

' The draught pf»escribed Mr Hecamede prepares.* 
And again, 



This /or the wounded prince the dame prepares.' 



Unfortunately, however, there is no sort of au- 
thority in the original for the above expressions, 
and it appears that Hecamede prepared the 
draught, probably of her own invention, to treat 
her master Nestor, as well as his guest Ma- 
chaon, and this, too, for the sole purpose of 
assuaging their thirst. 

ToTm S^ Tit/jjft xvMtim *»vnX6xaftos 'Ey.a^t\9n. IL X, 623. 
Tfti ^* lii%i ovv nivovj* it^irtjv noXvieayxia dixpav.* 641. 

It is a little remarkable that the learned pro- 
fessor should copy out the whole Greek passage 

• The translations of this passage by Cowper and Dacier are 
correct. Chapman has the same inaccuracy with Pope. 



350 ON THE EARLY 

for his book, and overlook such words as rotei, 
eip&'if, atpi and ru; or imagine them to be meant 
for Machaon individually. We are much in- 
clined to suspect that he placed undue reliance 
on the translation, when we find him leaving 
off his Greek in the middle pf a sentence, and 
observiug that ^ It might be difficult in English 
poetry to discover a translation more distin- 
guished for a happy mixture of precision and 
elegance, than the above version of Pope.' 

One more of these worthies, and then we 
have done with * heroic medicine.' We pre- 
sume that the name of Achilles will not yet 
descend to oblivion, even though our author 
should fail in his attempts to dub him also a 
doctor, of medicine. Nevertheless Achilles, it 
seems, was a pupil of Chiron ; he cured the 
wound of Telephus with the rust of his spear, 
and the plant Achilleea, or yarrow, had the honor 
to be named after him. But it ought not to be 
forgotten, that the circumstance of his pupilage 
was common to most of the pre-eminent heroes 
of his time, and that in the cure of Telephus he 
had scarcely any merit. Telephus consulted the 
oracle, and was told that his wound could only 



HISTORY OP MEDICINE. 351 

be healed by the same spear which had occa- 
sioned it Accordingly he applied to Achilles, 
whose spear had done the mischief, and re* 
quested his medical assistance. Achilles at first 
refased, saying that he was no physician, but 
afterwards wats prevailed on to scrape the rust 
of his spear into the wound, which in due time 
got well. With regard to the plant Achillsea, 
we presume its name has as much to do with 
medicine, as that of the plant Jeffersonia. 

We now come to consider the second depart- 
ment which Dr. Miller has made in the physic 
of Greece, viz. his Priestly medicine. As he 
has shown that the medicine of heroes was 
chiefly surgical, he now makes it equally clear 
that that of priests and conjurors was mere 
• practical physic' For this he gives us all the 
presumptive evidence which can arise from the 
natural ascendency of priests and wizards over 
the public mind, and from the analogy of cus- 
toms in all the barbarous nations in the world. 
He gives us, however, only two instances of 
priest-physicians in Greece, viz. Melampus and 
Orpheus ; of whom Melampus appears to us to 
have been only a fortune-hunter, who cured the 



352 ON THB EARLY 

daughters of Proetas, of real or pretended mad- 
ness, that he might gain the hand of one of his 
patients, together with her kingdom, in mar- 
riage; while with regard to Orpheus, there is 
very little authority for his having practised 
physic in any particular instance, and his high 
reputation is sufficiently supported by the es- 
tablished fact| that % 

' He played so well, lie moTed Old Nick.' 

On considerations like the foregoing we are 
disposed to ascribe to the ancient Greej^s the 
credit of very little real proficiency in the art 
of healing. From similar motives we doubt 
the correctness of Dr. Miller's belief, that Greece 
was indebted for its first discoveries and im- 
provements in medicine solely to two classes of 
men, viz. the chiefs or sovereigns, and the priests 
or ministers of religion. Unwilling, however, 
to interfere with the doctor's ardor for classifi- 
cation, we only suggest, for a second edition of 
his work, the propriety of adding a new class or 
department in primitive physic, to be called the 
department of old women^ or oi female medicine. 



HISTORY OF MEDICINE. 353 

These early practitioners of physic we think he 
has treated with unmerited neglect, for we will 
engage, where he produces one instance in 
Greece of a priest skilled in medicine, that we 
will furnish two of females possessing the same 
accomplishment. It is sufficient now to men- 
tion only the names of Circe, Medea, Angitia, 
Agamede, Helen and Oenone.* 

The last portion of our author's work em- 
braces the history of medicine in Egypt and 
the East ; and on this subject our limits com- 
pel us to be more brief. The advantages pos- 
sessed by the Eastern countries over European 
Greece for the early cultivation of science, are 
said to have been the coalition of their inhabi- 
tants into large and mighty empires, instead 
of petty states and communities ; and also the 
peculiar nature of their ecclesiastical institu- 
tions, in which an hereditary priesthood was 
placed in possession of all the facilities and 

* ' In these early ages all the knowledge of ihe tribe formed a 
common stock ; and their imperfect arts might be exercised by 
all those who were endowed with a certain portion of intelligence 
Medicine therefore existed before there were any regular phyi i* 
clans.' — CabanisU Revolutions of Med. Science, 
S3 



354 ON THE EARLY 

inducements for scientific speculation. The 
invention of letters, or alphabetic characters, 
was among them an early auxiliary to the 
cultivation of the sciences, and medicine was 
not the last to profit by so signal an advantage. 
Some of the earliest lettered productions con- 
tained copious treatises on the healing art as an 
integrant portion of their contents. 

The very ancient and celebrated personage 
Thothy or, as he is called by Dr. Miller, Tot^ and 
who is the same with Hermes, or Mercury of 
the Greeks, seems to have been the founder of 
medicine in Egypt. His writings, afterwards 
held sacred, were divided into forty-two books, 
six of which treated of medical subjects, viz. 
one of anatomy, one of diseases, one of instru- 
ments, one of medicaments, one of disorders of 
the eyes, and one of diseases of women. While 
the higher orders of Egyptian priesthood were 
employed in the study and execution of relig- 
ious and philosophical offices contained in the 
former books, a second or inferior class were 
busied in the study and practice of healing. 
The Pastophori, for so the cultivators of physic 
were called, were bound to make themselves 



HISTORY OP MEDICINE. 



356 



intimately acquainted with the medical scrip- 
tures of Thoth, and so long as their practice 
was strictly conformable to these, no blame was 
incurred by them. On the contrary, if any 
practitioner ventured to deviate in the least 
from these sacred rules, he became responsible 
with his own life for the safety of his patient. 
This circumstance must have furnished a pow- 
erful check to improvement, and kept the sci- 
ence of medicine long in a state altogether 
stationary. 

Of the other peculiarities in Egyptian prac- 
tice, the following are among the most remark- 
able. The art was made altogether hereditary, 
so that ^ he who was born a physician was pro- 
hibited equally by Heaven and by law from 
abandoning the occupation of his ancestors.' 
The profession was also subdivided into minute 
departments, so that each particular disease had 
a separate healer. Some took charge of disor- 
ders of the eyes, some of the head, some of 
the teeth, some of the abdomen, &c. The 
vast number of individuals who were engag- 
ed in some branch of medical practice, led 
to the assertion of Homer and Herodotus, 



356 ON THE EARLY 

that in Egypt eveiy man met with was a 
physician. 

What were the particular modes of practice 
enjoined by Thoth it is impossible now to 
know, for the books of the Pastophori have 
long since been lost. Dr. Miller, however, has 
indastrionsly attempted to glean whatever au- 
thorities were afforded respecting them, from 
their successors in art and science, the Greeks. 
He has told us that the Pastophori, and even 
the kings, were wont to immolate and dissect 
beasts and human victims, but with what pro- 
ficiency in anatomy it is not known. In the 
science of diseases they appear to have had 
some idea of critical days, to have divided 
disorders into acute and chronic, and to have 
ascribed their pestilential distempers to a mor- 
bific principle in the air. In the Materia Medi- 
ca they seem to have been acqucunted with 
many eflScacious articles, together with their 
most useful forms of composition. 

Having now run through the contents of this 
volume, we would observe that, in general, it 
is far from being an uninteresting production. 
The extent of the author's researches, and the 



HISTORY OF MEDICINE. 357 

ingenuity of his deductions, will afford some 
novelty and instruction to most readers. His 
predominant fault is a disposition to annex an 
undue consequence to circumstances which are 
doubtful or unimportant We think he might 
profit by the observation of Cabanis, that in a 
subject where materials to compensate inquiry 
are wanting, * the friends of truth should not 
lose their time in forming vain conjectureS| 
however learned they may happen to be,' 



ADDRESS 



DIUYIBID BEFORE 



THE AMERICAN ACADEMY OF ARTS AND SCIENCES. 

AT THE OPENIVG OF THXIK OOTJBSE OF LEOTUSES, 
OCTOBER 27, 1852. 



At a meeting of the American Academy of Arts and Sciences, 
June 22, 1852,— 

Mr. Agassiz, in behalf of the committee appointed to consider 
the best means of increasing the Academy's publication fund, 
reported, — that the committee were unanimous in recommend- 
ing that a course of public lectures of a popular character be 
given by Fellows of the Academy during the ensuing winter ; 
that the President be requested to commence the course by an 
Address setting forth the objects and aim of the course ; and 
that each section of the Academy appoint one of its number to 
deliver one lecture upon some special subject belonging to, and 
prominent in, the section's sphere of research. 

It has been a serious question whether amid 
the general sadness which hangs as a cloud over 



ACADEMY OF ARTS AND SCIENCES. S59 

our city, which has seemed to check the ordinary 
current of affairs, and to darken the very atmos- 
phere of social intercourse,* the pre-arranged 
exercises of this place should not be suspended 
in solemn and silent respect to the unusual oc- 
casion. But we are bound by circumstances to 
perform that which at this time we would not 
have wished to do. And leaving to the public 
voice the expression of that general emotion, to 
which no limited occasion can afford utterance, 
we shall proceed in the attempt to execute the 
more humble duty that has been set before us. 
I am instructed in behalf of the American 
Academy of Arts and Sciences to report to yoii 
this evening on the character and condition of 
that institution, and the objects of the present 
course of lectures. If it were possible that a 
Society which has existed in your midst for two 
or three generations, and which from time to 
time has numbered among its members many 
of the most enlightened and valuable of our cit- 
izens, could be in any measure unknown, I 
might safely rely on the more gifted laborers 
who are to follow me in this field, for the vindi- 

* The death of Daniel Webster. 



360 ADDRESS BEFORE THE AMERICAN 

cation of its character and name. And if the 
present occupation of this lecture room were a 
question of doubtful propriety, I might briefly 
say that the Academy needs, nay, more, that it 
deserves your countenance and support, and that 
this is the place and the manner in which your 
kind regards have been solicited towards the 
encouragement of its labors. But as the quiet 
operations of Science have not the wide-spread 
notoriety which attends the more absorbing 
questions of peace and war, of property and 
privilege, of safety and of danger, there is reason 
for attempting a more detailed consideration of 
the objects and results of our Academic Incor- 
poration. 

Academies in the higher use of the term, phi- 
losophical and learned societies, exist and have 
long existed in every country of civilized Eu- 
rope. In common with Colleges and Universi- 
ties they are designed to cultivate and dissemi- 
nate scientific truth, but unlike those institutions, 
the usual province of the modern Academy is to 
investigate rather than to teach, to bring together 
experts from the various walks of science, litera- 
ture and art, to accumulate for the benefit of the 



ACADEMY OF ARTS AND SCIENCES. 361 

whole the researches and observations of all, to 
aid and to encourage the different inquirers on 
their respective tracks, and to furnish vehicles for 
what is true, and ordeals for what is unsettledi 
in the progress of human knowledge. 

One of the early fruits of the restoration of 
arts and letters in Italy was the perception of 
the great advantage attending the combination 
of effort in Academic institutions. In that 
country were the first efficient examples of 
learned bodies cooperating for their common 
good, and bringing their united efforts to bear in 
the promotion of the arts and sciences. From 
Italy the principle of Academic association 
spead to England, Germany, and France, and 
in all those countries, noble institutions, having 
their foundation in the earnest quest of truth, 
and supported by the zeal and learning of the 
best men of their times, have been sent down to 
the present age, marking their way by many 
high developments of human intellect, and noble 
achievements of human science. Some of them 
which for two centuries have enjoyed the sun- 
shine of royal and public patronage, now find 
themselves entrenched in ample halls, surround- 



362 ADDRESS BEFORE THE AMERICAN 

ed by the machinery of modern science, dispens- 
ing rewards with princely prodigality, offering 
seats of which the prospective vacancy fills with 
ambition the learned of foreign countries, throw* 
ing lustre on the cities of their respective estab- 
lishment, and connected by little resemblance, 
save that of etymology, with the simple pre- 
ceding groves of Plato and Arcesilaus. 

Academic institutions have differed widely 
Irom each other in the object as well as the 
comprehensiveness of their pursuits. Not only 
does the history of literature furnish many ex- 
amples of Academies of Sciences and the Arts, 
but there are well-known like institutions of 
Belles Lettres, of Language, of Inscriptions, of 
Painting, Sculpture and Architecture, of Music, 
of Antiquities, and of many subordinate branches 
of useful and of elegant learning. Of course 
the value of membership in any of these bodies 
has depended on the character of the institution 
itself, and the principles on which it is conduct- 
ed. The Royal Academy of France, often 
known par excellence as the Academy^ not only 
under its original name, but under the subse- 
quent appellations of National and Imperial 



ACADEMY OF ARTS AND SCIENCES. 363 

Institute, has during a long period of years, sus- 
tained an almost uninterrupted preeminence in 
the republic of letters. The labors of this body 
have cast a flood of light on modern science, 
and its assembled savans have formed a tribunal 
from whose scientific sentence there seemed no 
appeal. Yet even this institution, under the 
Occasional supineness of its members, and the 
influence of royal favoritism, has more than 
once been a mark for the shafts of cotempora- 
neous criticism. The poet Piron, affecting to 
define his own humble position by an epitaph, 
says, ^ Here lies Piron, who was nothing at all, 
not even an Academician.' 

In the year 1779, in the midst of the exhaust- 
ing and yet unfinished contest of our Revolution, 
with humble resources, but with confidence of 
future promise, the American Academy of Arts 
and Sciences was founded by an association of 
citizens of Massachusetts. The fathers of our 
Commonwealth, well aware that the lights of 
liberty and learning are jointly conducive to the 
stability of free government, gave their sanction 
and in many cases their individual efforts to 
construct the foundation of an ample edifice. 



364 ADDRESS BEFORE THE AMERICAN 

Among the constellation of worthies enrolled as 
its first members, we find the names of the two 
Adamses, of Bowdoin and Gushing, of Chaun- 
cey and Cooper, of Hancock, of Lowell, of Sedg- 
wick, Strong and Sullivan, and about fifty 
others, all of them names already registered in 
the annals of their country's service, or distin- 
guished as proficients in the learning of their 
time. 

The preface to their first publication states 
that the Legislature was called on to sanction 
the society on a liberal and extensive plan, and 
to establish it on a firm basis. ^ And to the 
honor of our political fathers,' say they, * be it 
spoken, that although the country was engaged 
in a distressing war, a war the most important 
to the liberties of mankind that was ever under- 
taken by any people, and which required the 
utmost attention of those who were entrusted 
with our public concerns, they immediately ad- 
verted to the usefulness of the design, entered 
into its spirit, and incorporated a society with 
ample privileges.' 

But the approval of the Legislature was but 
a small offset to the difficulties against which 



ACADEMY OF ARTS AND SCIENCES. 36S 

the new association had to contend. ^ The 
country being young,' say they, * few among us 
have such affluence and leisure as to admit of^ 
our * applying much time to the cultivation of 
the sciences.' And in another place, <many im- 
portant European discoveries have been in a 
great measure useless to this part of the world, 
in consequence of a situation so remote &om 
the ancient seats of learning and improvement. 
And of such publications as have reached this 
country, the smallness of the number has greatly 
limited their usefulness, as but few have had the 
opportunity for perusing them.' 

Under such disadvantages, so unlike the state 
of things now, well might our courageous pred- 
ecessors solace and assure themselves by a pro- 
spective view of the harvests they were sowing 
for their descendants. * Settled,' say they, < in 
an extensive country, bordering upon the ocean, 
and open to a free intercourse with all the 
commercial world, — a country comprehending 
several climates and a rich variety of soils, 
watered and fertilized by multitudes of springs 
and streams, and by many grand rivers, — the 
citizens have great opportunities and advan- 



366 ADDRESS BEFORE THE AMERICAN 

tages for making useful experiments and im- 
provements whereby the interests and happiness 
of the rising empire may be essentially advanced. 
At the same time enjoying, under a mild but 
steady government, that freedom which excites 
and rewards industry and gives a relish to life, 
— that freedom which is propitious to the diffti- 
sion of knowledge, which expands the mind and 
•engages it to noble and generous pursuits, — 
they have a stimulus to enterprise which the 
inhabitants of few other countries can feel.' 

Such were the principles and the auspices 
under which was kindled the small dim light of 
our Academy. Although it was not often over- 
ffed with fuel, nor at all times watched with 
vestal vigilance, it has at least never been suf- 
fered to go wholly out, and, after glimmering 
with uncertain yet increasing rays for two-thirds 
of a century, it has at length grown to be an 
acknowledged beacon in science, a light to 
the philosophic of our own country, a western 
star to whose unshadowed brilliancy and true 
monitions the European world now looks with 
interest and respect. 

The early labors of the Academy were in 



ACADEMY OF ARTS AND SCIENCES. 867 

keeping with its early professions. They did 
not trench deeply on fields appropriated by for- 
eign explorers, but rather turned their inquiries 
to the capacities of their own country, to the 
improvement of its practical advantages and the 
knowledge of its natural history. With the 
exception* of a few limited papers in mathe- 
matics and astronomy, the first volumes of the 
Transactions are occupied with such objects as 
the cultivation of corn and the engrafting of 
trees, examination of springs of water, and 
reports on diseases of cattle, speculations on 
natural caves, recorded earthquakes and conjec- 
tured volcanoes. Narratives are given of the 
appearance of water-spouts, and of remarkable 
devastations of lightning on trees, rocks and 
dwelling-houses. Fossil frogs, Hhat under the 
cold stone* were believed to have passed monot- 
onous ages of incomprehensible existence, are 
presented in these memoirs, living and jumping 
before- the reader. Flocks of swallows, black- 
ening the air with their numbers, abandon the 
joyous, twittering, feather-chasing career of 
their summer life, and with ominous solemnity 
assemble on the banks of some stagnant pool, 



368 ADDRESS BEFORE THE AMERICAN 

rendered famous perhaps with the tradition of 
former engulphments of their species, and then 
— are seen no more. A cloud settles on the 
mystery of their wintry existence, and the won- 
der was that when they appeared in the follow- 
ing spring, their sleek and glossy plumage bore 
no traces of the deep mud under which they 
were believed to have slept out their hyberna- 
tion. 

The riches of our vegetable kingdom and the 
importance of establishing a more thorough and 
practical knowledge of its different portions, did 
not escape the attention of the pioneers of our 
natural history. Great difficulties beset the 
early botanists in the prosecution of their inqui- 
ries, from the novelty of the subject, the paucity 
of books, and the difficulty of maintaining cor- 
respondence with foreign scientific authorities, 
in those cases where books are insufficient and 
knowledge to a certain extent must be ocular 
and traditionary. Yet the Rev. Dr. Cutler, of 
our State, has culled for himself an enduring 
garland from a field in which it would appear 
that the harvest was plenteous, but the laborers 
were few. 



ACADEMY OF ARTS AND SCIENCES. 36d 

The valleys of New England ^re not the seat 
of antiquities and hieroglyphic records, yet in 
the earlier volumes of the Transactions there is 
more than one account of the memorable in- 
scription on our far-famed Dighton rock. This 
curious relic of the scattered and now fast dis- 
appearing aboriginal inhabitants of our country, 
is copied and described by various persons, and 
hypothetically explained by the late excellent 
Judge Davis of this city. Whatever be the 
mystery it involves, a hunting scene or a relig- 
ious rite, an achievement of war or of conquest, 
the pages of the Academy offer a faithful fac- 
simile for the use of foreigners and of posterity, 
who may happen to find themselves called and 
competent to its perusal. 

But by far the n^ost ambitious among the 
early speculations of t|ie Academy, is the theory 
of Governor Bowdoin, then President of the In- 
stitution, on the existence in the universe of an 
all-surrounding orb. That distinguished gentle- 
man and scholar, after various speculations on 
the supposed waste of material light from the 
surface of the sun, and the danger to all mate- 
rial bodies from their own unresisted gravity 
2i 



870 ADDRESS BEFORE THE AMERICAN 

attracting them towards each other, published 
an elaborate memoir, entitled ^ Observations 
tending to prove by phenomena and scripture, 
the existence of an orb which surrounds the 
visible material system, and which may be 
necessary to preserve it from the ruin to which, 
without such a counterbalance, it seems liable, 
by that universal principle in matter, gravita- 
tion.' 

The author satisfies himself by a train of 
ingenious reasoning, of the sufficiency of his 
theory to prevent the apprehended catastrophe. 
He deals not only with the necessities of such 
an arrangement to produce stability in our uni- 
verse, but draws supernumerary arguments from 
the presence of the milky way, the blue color of 
the firmament, and lastly from various corrobo- 
rative texts of scripture. 

History is silent in regard to the extent of the 
impression made upon the world by the promul- 
gation of this comprehensive theory. The orb 
is supposed to have been standing several years 
after the announcement of its character and 
office, — and when it fell, the Academy, nothing 
daunted, proceeded to prosecute its celestial in- 



ACADEMY OF ARTS AND SCIENCES. 371 

vestigations with a zeal and tenacity of purpose 
prophetic of its future more elevated destiny. 

tenaoem proposiU 

si fraotus illabatur orbis 

ImpaTidum ferient roinsB. 

Should any one incline to disparage the 
labors of our predecessors on account of their 
honest and earnest, though sometimes misdi- 
rected inquiries for truth, he will find parallel 
examples in the early history of every learned 
body in Europe of a century's standing. The 
first publications of the oldest philosophical 
societies contain speculations on the transmuting 
of metals, projects for perpetual motion, schemes 
for raising water without power, and for flying 
in the air by machinery, credulous inquiries 
about secret poisons and fabulous natural pro- 
ductions. They did not think it beneath them 
to investigate extravagant rumors, and they 
often propounded interrogatories with this view, 
to foreign ambassadors, missionaries, merchants 
and navigators. The Royal Society of London 
sent many grave inquiries to Sir Philberto Ver- 
natti, then resident in the Indies, in hopes 
to solve some of the difficulties which were 



373 ADDRESS BEFORE THE AMERICAN 

weighing upon them. The first of these was, 
^ Whether diamonds and other precious stones 
grow again after three or four years in the same 
places where they have been digged out.' The 
catagorical answer to this question is, * Never.' 
Another inquiry is, * Whether in the island of 
Sombrero there be found such a vegetable as 
Master James Lancaster relates to have seen, 
which grows up to a tree, Bhrinks down when 
one offers to pluck it, and would quite shrink 
unless held very hard.' Sir Philberto replies, 
that he < cannot meet with any that ever heard 
of such a vegetable.' 

Again they inquire, * Whether the Indians 
can so prepare that stupefying herb Datura, that 
they may make it lie several days, months, 
years, according as they will have it, in a 
man's body, and at the end kill him without 
missing half an hour's time.' 

The 29th question is, ' Whether there be a 
tree in Mexico that yields water, wine, vine- 
gar, oil, milk, honey, wax, thread, and needles.' 
The answer here is more encouraging, <The 
Cocos trees yield all this, and more.' 

In the inquisitiveness and credulity which 



ACADEMY OF ARTS AND SCIENCES. 873 

marked these early stages of scientific inquiry, 
we have at least the gratifying assurance, that 
our philosophic fathers did not close their ears 
against the reception of knowledge, from what- 
ever quarter it might proceed. They were just 
emerging from the deep intellectual darkness, 
which for long ages had brooded over the world. 
They were the survivors of many generations, 
among whom to inquire had been a crime, to 
reason had been a heresy, and to experiment a 
satisfactory evidence of intercourse with the 
powers of darkness. Secretly, and by stealth 
and stratagem, the germs of science had here 
and there been nourished into visible life, but 
the air and the sunlight of heaven were denied 
to their upward expanding tendencies. And 
when at length, with the Reformation, the revi- 
val of letters and the introduction of the print- 
ing press, a veil was lifted from the moral and 
material world, no wonder that inquiring eyes 
were dazzled and strong heads were turned with 
the startling developments of the solar system, 
the circumnavigation of the globe, and the prac- 
ticable intercourse of men and nations with each 
other. 



374 ADDRB88 BEFORE THE AMERICAN 

The comparatively short period during which 
the American Academy has existed, has been 
one of advanced and rapid progress in the histo- 
ry of science throughout the world. It has been 
the era of the Herschels and Laplace, of Lavoi- 
sier and of Davy, of Cuvier, of Watt, and a host 
of gigantic minds, whose conquests over un- 
known regions will never be obliterated from 
the map of science. During this period of pro- 
gress, the small number and limited opportuni- 
ties of the scientific men of our own hemisphere 
have been such as to render them lookers-on, 
recipients and dispensers, rather than origina- 
tors of new discovery. For many years the 
publications of this Academy were so sparse and 
inconsiderable as to induce serious question from 
some foreign scientific bodies, whether the usual 
exchange of printed transactions were worth 
keeping up. There was a long period, during 
which the late venerated Bowditch seemed to 
be the almost solitary pillar on whose support 
the Academy relied for its character and position 
in the philosophic world. And to his praise be 
it said, that while engaged in the surpassing 
labors which have constituted the monument 



ACADEMY OF ARTS AND SCIENCES. 375 

of his living and posthumous fame, he never 
shrunk from identifying his name with a small, 
and then almost obscure institution of his native 
country. Punctual in his attendance on its 
meetings, earnest in his appeals to the lag- 
ging industry of its members, foremost in every 
movement for its prospective welfare, pouring 
into its vacant pages the overflowings of his 
own exuberant mind, he was not only a centre, 
but a central fire ; not only attracting but excit- 
ing, warming, illuminating all within the circle 
of his influence. By his side walked the accom- 
plished Pickering, laborious, erudite, modest, a 
votary of learning for its own sake, whose capa- 
cious and cultivated mind, aflluent in various 
lore, seemed poor only to his own aspiring and 
comprehensive genius. 

By these men, more than all others, in the 
day of its obscurity, was this Academy cherished 
and upheld. They did not feel authorized to 
boast much of its history nor of its existing per- 
formances. They were not vainglorious of their 
own share in whatever of reputation it might 
have happened to acquire. But they felt and 
expressed that in it was contained the germ of 



476 ADDRESS BEFORE THE AMERICAN 

fature development, that to a certain extent it 
had books, and endowments, and position, that 
it was their duty and that of their cotemporaries 
to cultivate its capacities, to improve its con- 
dition, and at least to preserve it unimpaired, 
until the increasing population and wealth in 
our country, and correspondent increase of the 
men and means of science, should impart to it a 
vigorous vitality, like that which sustains the 
older institutions of Europe. 

We do not assume too much in saying that 
this period has at length arrived. The thinly 
attended meetings, few and far between, in 
which a quorum was with difficulty convened, 
perhaps only to spend an hour in debating a 
by-law or electing a foreign fellow, have been 
replaced by monthly and semi-monthly gather- 
ings, in which the time is often too short to give 
utterance to the accumulated researches of the 
members. The demand for publication of new 
and important matter outstrips the limited re- 
sources of the treasury, and now brings the 
institution before the public of this city, a solici- 
tor for the hearing of its claims. What is it 
that this Academy, through its members, is now 



ACADEMY OF ARTS AND SCIENCES. 377 

performing ? What is it that it asks the means 
of publishing to the world? Not the meagre 
and uninteresting record of every-day phenom- 
ena. Not the premature speculations of unqual- 
ified reasoners on more expanded subjects. 
Not the repeated lessons received with un- 
questioning docility from the higher sources of 
transatlantic wisdom. It now rather sits in 
judgment on unsettled questions of European 
science, and pushes its own unaided investiga- 
tions beyond the previous bounds of human 
knowledge. Its researches during the last five 
or six years have been such in magnitude and 
importance that they may without disadvantage 
be brought into comparison with those of many 
of the time-honored institutions of the old world. 
Closely connected with our distinguished Univer- 
sity, numbering among the teachers of that sem- 
inary a large portion of its most accomplished 
and efficient members, making the pages of its 
publications a vehicle for the light which ema- 
nates from the observatory, the apparatus, the 
collections of that venerable seat of learning, 
aided moreover by the naturalists, the philoso- 
phers and the annalists of other societies among 



378 ADDRESS BEFORK THE AMERICAN 

ns, it has established an inflaence which conid 
not well be now spared from the republic of 
science. 

We may say, without fear of contradiction, 
that there are few branches of physical knowl- 
edge which have not been illustrated or enlarged 
by the members of this body, and when difficult 
labors are to be performed, or difficult problems 
to be solved, no source of information in our 
country has been deemed more reliable, or more 
frequently been put in requisition, than the au- 
thority of this Academy. The plants of Cali- 
fornia and New Mexico have repeatedly come 
here to be named and described. The late 
exploring expedition sent to this city a large 
portion of its collected treasures, for investiga- 
tion and judgment. The fossil bones of gigan- 
tic quadrupeds are accumulated in our midst 
with a completeness and abundance such as is 
found in no other place ; and they are presented 
to the world with an amplitude of scientific 
delineation, seldom, if ever, surpassed. Huge 
limbs and heads of undescribed troglodytes, 
exceeding those of man which they counterfeit, 
and whose race is now living in African 



ACADEMY OF ARTS AND SCIENCES. 379 

forests, have received their first description in 
this city. 

The pages of our Transactions offer the faith- 
ful impress, not elsewhere found, of the foot- 
prints of colossal birds and mysterious reptiles, 
transferred from the banks of our own rivers, 
where, awaiting the perusal of the naturalist, 
they have lain for unknown ages, stereotyped in 
stone. It is fresh in our recollection, that when 
the credulity of the popular voice, not without 
the assent of men of science, had given a ficti- 
tious reality to a monster compounded of con- 
tributions levied from many individuals, and 
when this deception gained foothold not only in 
our own greatest city, but afterwards in one of 
the enlightened capitals of Germany, the doubt 
was removed and the deception made man- 
ifest by the scientific sentence of one of this 
Academy. 

A few years ago a call was made by the Le- 
gislature of this Commonwealth for researches 
into the various departments of its indigenous 
natural history. This call was promptly and 
ably responded to, and the reports returned on 
the geology, the forest trees, the fishes, the in- 



880 ADDRBSa BEFORE THE AlUSRIOAN 

sects, and the other invertebrata of Massachu- 
setts, were in the highest degree creditable to 
those Academicians from whose labors they 
emanated. Some of these subjects are yet 
waiting the results of this course of lectures, to 
give their illustrations to the public 

The incipient mysteries of organic develop- 
ment, the structure and transformations of the 
animalcular world, the scarce visible organisms 
which fill our waters with busy and effective 
life, the unknown generations which have writ- 
ten with their own remains the history of 
preceding nature, have oftea been drawn from 
obscurity, their laws and limits studied, and 
many of their new and unknown forms for the 
first time described and arranged by one of our 
adopted members, whom we may well place in 
the foremost rank of living naturalists. And as 
if to indicate the claim to notice of what might 
seem a humble department of zoology, we have 
been taught from the same indefatigable source, 
that since the period of man's existence on this 
globe, a vast peninsula, constituting nearly an 
entire State of this Union, has been raised from 
the bottom of the ocean and added to the previ- 



ACADEMY OF ARTS AND SCIENCES. 381 

ons continent by the silent conspiring agency of 
coral polypes. 

When we turn our inquiries in another direc- 
tion, we find that the study and knowledge of 
the electric power has not deserted the country 
of Franklin. This mighty agent, before which 
men trembled in former ages, believing, in their 
alarm, that Jove was wielding his bolts, or Hhat 
spirits were riding the Northern light,' — has 
become, in philosophic hands, the docile mes- 
senger of thought over our vast country, and 
the faithful monitor of danger in our cities, and 
seems about to reveal the very measure of its 
velocity to the persevering interrogations of 
members of this Academy. 

I should weary you with detail, were I to 
recount the various contributions made among 
us to mathematical, chemical, economical, me- 
chanic, and microscopic science, and to the 
natural history of the globe and of its inhabi- 
tants. I might say that the tornado which last 
year swept over a neighboring district, has left 
on our pages an impress more minute than ever 
whirlwind left before. I might say that the 
forthcoming nautical almanac, the joint and 



382 ADDRESS BEFORE THE AMERICAN 

ardaons production of our mathematicians, will 
stand in the foremost rank of similar authori- 
ties. I might bring before you the perfected 
turbine wheel, and the elaborate cordage ma- 
chinery, as examples of the mechanical ability 
and inventive genius of our academicians ; and 
I might cite many instances of energetic coope- 
ration with other bodies, in the magnetic ob- 
servations, in meteorology, in the coast survey, 
and in the general advancement of geographi- 
cal and philosophic knowledge. 

Conspicuous above other sciences, for the 
vastness of its objects, and the amount of in- 
tellectual effort which it has called into being, 
stands Astronomy, one of the eariiest, the most 
dif&cult, and most successful studies of the hu- 
man mind. For many years the discoveries of 
its observers, and the results of its analysts, 
have, by the common consent of central and 
northern Europe, been chronicled in one place 
in the city of Altona, in the astronomical jour- 
nal of the eminent Professor Schumacher. But 
Schumacher is dead, and his divided mantle 
has fallen upon the shoulders of more than one 
competent successor. The only journal in the 



ACADEMY OF ARTS AND SCIENCES. 383 

English language, now devoted to pure astro- 
nomical science, regularly reporting, with dis- 
criminating exactness, the advances made in 
that department of knowledge, and enriched by 
contributions from both sides of the Atlantic, 
as well as from its own editor, is now published 
in this country, and issues periodically from the 
press of Cambridge in Massachusetts. 

It has not been in vain that public liberality 
has provided our University with instruments 
capable of penetrating the depths of space. It 
has found in that place eyes adequate to per- 
ceive, and minds competent to analyze, IJie 
abstruser revelations of astronomical science. 
The meetings of this Academy have heard the 
announcement of new celestial bodies, and the 
assignment of unexpected laws to others al- 
ready familiar to the European world. Who 
is there, from the schoolboy to the sage, who 
has not dwelt and gazed and speculated on the 
mysterious ring that surrounds the planet Sat- 
urn? Who has not wondered at this excep- 
tional feature of the known universe, and plant- 
ed himself in imagination on the surface of that 
distant sphere, that he might seem to contem- 



384 ADDRESS BEFORE THE AMERICAN 

plate the radiant arch that spanned its unknown 
firmament? Yet this remaining anomaly of the 
visible creation, this marvel and study of mod- 
ern astronomy, has been destined to reveal its 
structure at our own observatory. And the 
necessity of its fluid nature, and the laws by 
which it is sustained, have been deduced from 
the observations, and established by the pro- 
found analysis of our own astronomers. 

'Need I call up before this audience the re^* 
cent fame of that far ulterior planet, which, 
since the creation of the world, has held its dim 
and undetected course around the verge of our 
solar system, until at length its remote presence 
so weighed upon the instructed sense of the 
Parisian philosopher, that it was felt and known 
even before it was seen? And need I say that 
this object of absorbing interest, this wonder of 
its time, after justifying in some measure the 
rival claims to its discovery of the three most 
enlightened nations of Europe, came at last to 
receive the determination of its true orbit, posi- 
tion, mass and motion from the geometers of 
our own Academy? 

I have said enough to show, that the Ameri- 



ACADEMY OF ARTS AND SCIENCES. 385 

can Academy of Arts and Sciences has earned 
for itself a position among similar institutions 
of the world ; and although, from the necessary 
limits of the occasion, I have not been able to 
take fitting notice of other investigations made 
here for the advancement of knowledge and 
other worthy achievements in the parallel walks 
of literature, yet without arrogance I might as- 
sert that, in the different sections of this Acade* 
my, embracing the great departments of modern 
research and cultivation, men are now found 
competent to perceive truth, and qualified to 
return light, on the varied objects of human 
science. 

It is not necessary to say, that the meetings 
of such a body afford a nucleus, around which 
are attracted and concentrated the contributions 
of most of our scientific men. And the regu- 
larly published proceedings of this body are the 
vehicle through which are given to the world 
the results of their labors. 

It ought not then to be said that, in this 
enlightened community, the efforts of so active 
and efficient an institution should be embarrass- 
ed by financial deficiencies. Yet such is the 
35 



386 ADDRESS BEFORE THE AMERICAN 

uniform excess of its expenditures over its lim- 
ited income, that the Academy is not able to 
procure the books wanted for the information 
of its members, nor to issue the publications 
which should give utterance to its own investi- 
gations. So far from enjoying the promptness 
and amplitude of appearance which attend the 
productions of similar institutions abroad, it has 
happened, more than once, that the discoveries 
of our scientific men have had to wait, until 
they were actually superseded by the same dis- 
coveries abroad, because the printed pages and 
the illustrations of the engraver could not be 
commanded at the requisite time. 

As a nation we are proud of whatever con- 
tributes to our national glory. We are boastful 
of our growth, our political progress, our victo- 
ries, our annexations. We are proverbially sen- 
sitive, even in small matters, to questions of 
precedence and subordination, and we give our 
undivided sympathy even to a national contest 
ol locksmiths. The triumph of nautical skill 
in a distant boat race binds this Union more 
firmly together, by the common thrill of exulta* 
tion which vibrates from Maine to Texas. 



ACADEMY OF ARTS AND SCIENCES. 387 

Have we then no place for the rising star of 
science? Shall we avert our eyes from the 
dawning light, because its rays do not fall on 
US from the accustomed east? Have we no 
encouragement for those, our countrymen, to 
whom the old world is beginning to yield its 
reluctant honors ? Are we incapable of appre- 
ciating the value of scientific progress, and the 
importance that our own country should not be 
last in the general march of improvement which 
characterizes the present age ? Such has not 
been the character and usage of this our city. 
Such could not have been the expectation of 
those who, in adverse times, planted and nour- 
ished among us seeds capable of a redundant 
harvest. 

I have thus, ladies and gentlemen, endeavor- 
ed to present to your favorable notice, the char- 
acter and claims of the Academy of Arts and 
Sciences. In the course of lectures which is to 
follow, the Academy will speak for itself. I am 
aware that it is presumptuous for one absorbed 
in the cares of a responsible profession, who 
has added little to the common storehouse of 
indigenous science, to appear as the advocate 



388 ADDRESS BEFORE AMSRIOAN AOADEMT. 

and representative of so distinguished a body. 
Bat I am impressed with the importance of the 
occasion, and obey the commands which have 
been laid upon me; and I will shelter myself 
under the belief, that it may sometimes be per- 
mitted, even to the drone in the hive, to cause 
the air to vibrate in honor of the labors of his 
more efficient colleagues* 



INDEX. 






Page 




Pagt 


Abstinence in Diet, 


144 


Cochituate Water, 


818 


Academy American, Ad- 




Coffee, 


289 


dress, 


359 


Colchicum, 


143 


Acate Rheumatism, 


24 


Cutaneous Diseases, 


24 


Amphoric Resonance, 


280 






Anatomy and Surgery, 


94 


Definition of Medicine, 


64 


Andre, Major, 


190 


Detrimental Practice, 


40 


Angina Pectoris, 


22 


Detrimental Remedies, 


82 


Ascarides, 


50 


Diagnosis, 


67 


Auburn, Mount, 171 


,192 










Earle, Sir James, 


149 


Blane, Sir Gilbert, 


87 


Education, Medical, 


91 


Borromeo, Carlo, 


187 


Edward L King, 


175 


Botanic Practitioners, 


105 


Egyptian Medicine, 


254 


Bowditch, Nathaniel, 


874 


Electricity, 


881 


Burial of the Dead, 


171 


Elephant, fh>zen. 


186 


Bums and Scalds, 


146 


EpUepsy, 


21 






Erysipelas, 


12 


Causes, Removal of. 


57 


Esculapius, 


246 


Chalk Stones, 


135 


Etiology, 


93 


Charles I. King, 


178 


Exact Sciences, 


59 


Chemistry, 


92 


Exaggeration, Medical, 


95 


Clot Bey, 


76 


Expectant Practice, 


103 



390 


INDEX. 




Fire, Injuries by. 


146 


Metastatic Diseases, 


23 






Mount Auburn, 171, 


,192 


Goat, 49, 


,132 


Mncuna Pruriens, 


266 


Grecian Medicine, 


842 


Mummies, Egyptian, 


187 


Harmony among Physi- 




Neptune, Planet, 


384 


cians, 


123 


Nomenclature, 


287 


Henry VIII. King, 


183 


Numerical Method, 


84 


History of Medicine, 


888 






Homoeopathy, 


101 


Organic Remains, 


880 


Hooping Cough, 


10 










Paroxysmal Diseases, 


21 


Incurable Diseases, 


88 


Partridge, Poison of, 


272 


Inefficacy of Treatment, 


76 


Pathology, 


98 






Pestilential Epidemioi, 25, 54 


Kentish, Mr. 


148 


Pharmacopceia Ameri- 




Kinglake, Dr. 


148 


can, 


231 


Kings, Belies of. 


178 


Pickering, John, 


376 






Plague at Cairo, 


76 


Lead, Exposure to, 


316 


Pneumothorax, 


195 


Lead Pipes for Water, 


315 


Practical Medicine, 


62 


Lectures, Medical, 


97 


Precocious Habits, 


111 


Louis, 


84 


Priestly Medicine, 


861 






Private Schools, 


98 


Materia Medica, 


98 






Measles, 11, 43 


Quackery, 108 


1,124 


Medical Education, 


91 






Medical Profession, 


111 


Babbits, Experiments on 


, 152 


Medical Beasoning, 


29 


national Practice, 


35 


MetaUic Tinkling, 197 


'.224 


Remedies, 


66 



INDEX. 



391 



fiemedics, excessive, 


82 


Textures, Susceptibility 




Rheumatism, Acute, 


24 


of, 


269 






Theories in Medicine, 


118 


Scarlet Feyer, 


11 


Thomsonian Sect, 


105 


Self-limited Diseases, 


1 


Tobacco, History of, 


823 


Small Pox, 


12 


Treatment of Disease, . 


59 


Success of Treatment, 


26 


Typhoid Fever, 


14 


Symptoms, prescribing 


for, 79 






Syphilis, 


• 42 


Vinous Liquors, 


188 


Tanquerel on Lead, 


318 


Watch, Illustration by, 


69 


Tea, 


297 








V 



386 ADDRES9 BEFORE THE A.MERICAN 

uniform excess of its expenditures over its lim- 
ited income, that the Academy is not able to 
procure the books wanted for the inforniatjoa 
of its members, nor to issue the publications 
which should give utterance to its own investi- 
gations. So far from enjoying the proraptnesa 
and amplitude of appearance which attend the 
pToductiona of Bimilar institutiona abroad, it haa 
happenedj more than once, that the discoveries 
of our scientific men have had to wait, until 
they were actually superseded by the same dis- 
coveries abroadj because the printed pages and 
the illustrations of the engraver could not be 
commanded at the requisite time. 

As a nation we are proud of whatever con- 
tributes to our national glory. We are boastful 
of our growth, our political progress, our victo- 
ries, our annexations. We are proverbially sen- 
sitive, even in small matters, to questions of 
precedence and subordination, and we give our 
undivided sympathy even to a national contest 
ot locksmiths. The triumph of nautical skill 
in a distant boat race binds this Union more 
firmly together, by the common thrill of exulta- 
tion which vibrates from Maine to Texas. 



I 



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